Healthcare Provider Details

I. General information

NPI: 1205065596
Provider Name (Legal Business Name): PATRICK MICHAEL FERRISS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 07/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST
JACKSON MS
39216-4500
US

IV. Provider business mailing address

98 PINEHAVEN PL
CLINTON MS
39056-9322
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-5570
  • Fax:
Mailing address:
  • Phone: 601-201-3944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberT-2201
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: