Healthcare Provider Details

I. General information

NPI: 1073596094
Provider Name (Legal Business Name): GREGORY F FERRARA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13828 COURSEY BLVD
BATON ROUGE LA
70817-1307
US

IV. Provider business mailing address

13828 COURSEY BLVD
BATON ROUGE LA
70817-1307
US

V. Phone/Fax

Practice location:
  • Phone: 225-751-1544
  • Fax: 225-751-1909
Mailing address:
  • Phone: 225-752-4530
  • Fax: 225-752-4652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number015137
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: