Healthcare Provider Details

I. General information

NPI: 1770677072
Provider Name (Legal Business Name): JEFFREY FERRYMAN P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 10/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 VIRGINIA AVE
CONNERSVILLE IN
47331-2833
US

IV. Provider business mailing address

1941 VIRGINIA AVE
CONNERSVILLE IN
47331-2833
US

V. Phone/Fax

Practice location:
  • Phone: 765-825-5131
  • Fax: 765-827-7863
Mailing address:
  • Phone: 765-825-5131
  • Fax: 765-827-7863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10000902A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: