Healthcare Provider Details

I. General information

NPI: 1467474080
Provider Name (Legal Business Name): FERRIS E GEORGE JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 HEALTH PARK BLVD SUITE 105
ST AUGUSTINE FL
32086
US

IV. Provider business mailing address

201 HEALTH PARK BLVD SUITE 105
ST AUGUSTINE FL
32086
US

V. Phone/Fax

Practice location:
  • Phone: 904-824-1776
  • Fax: 904-825-1270
Mailing address:
  • Phone: 904-824-1776
  • Fax: 904-825-1270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME0051947
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: