Provider Demographics
NPI:1699892422
Name:TERAN, ADOLFO ENRIQUE (MD)
Entity type:Individual
Prefix:MR
First Name:ADOLFO
Middle Name:ENRIQUE
Last Name:TERAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:835 7TH ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-2190
Mailing Address - Country:US
Mailing Address - Phone:352-404-8961
Mailing Address - Fax:352-404-8996
Practice Address - Street 1:835 7TH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2190
Practice Address - Country:US
Practice Address - Phone:352-404-8961
Practice Address - Fax:352-404-8996
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2012-03-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME97840207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAE342ZMedicare PIN