Healthcare Provider Details

I. General information

NPI: 1619940202
Provider Name (Legal Business Name): WILLIAM BRUCE FERRARA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 01/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 HULSE RD
PENSACOLA FL
32508-1089
US

IV. Provider business mailing address

1047 SAN SEBASTIAN CIR
PENSACOLA FL
32506-9727
US

V. Phone/Fax

Practice location:
  • Phone: 859-452-2457
  • Fax: 850-452-2679
Mailing address:
  • Phone: 850-455-2528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License NumberG59487
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: