Healthcare Provider Details

I. General information

NPI: 1154324903
Provider Name (Legal Business Name): JAMES C. FERRARO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6622 N 91ST AVE STE 200
GLENDALE AZ
85305-2569
US

IV. Provider business mailing address

6622 N 91ST AVE STE 220
GLENDALE AZ
85305-2569
US

V. Phone/Fax

Practice location:
  • Phone: 623-547-4668
  • Fax: 623-535-7869
Mailing address:
  • Phone: 602-759-6883
  • Fax: 602-224-3358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number2854
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: