Provider Demographics
NPI:1528066123
Name:CLOWER, TERRY MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:MICHAEL
Last Name:CLOWER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 YALE PL
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-4611
Mailing Address - Country:US
Mailing Address - Phone:719-275-4151
Mailing Address - Fax:719-275-3743
Practice Address - Street 1:614 YALE PL
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-4611
Practice Address - Country:US
Practice Address - Phone:719-275-4151
Practice Address - Fax:719-275-3743
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20545207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCL18871OtherBLUE CROSS OF COLORADO
CO01205459Medicaid
COC397118Medicare PIN
COCL18871OtherBLUE CROSS OF COLORADO