Healthcare Provider Details

I. General information

NPI: 1255466348
Provider Name (Legal Business Name): GARY M MCFERRON CO, CPED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 OFFICE PARK DR
JACKSONVILLE NC
28546-7325
US

IV. Provider business mailing address

12 OFFICE PARK DR
JACKSONVILLE NC
28546-7325
US

V. Phone/Fax

Practice location:
  • Phone: 103-539-0029
  • Fax: 910-353-9003
Mailing address:
  • Phone: 910-353-9002
  • Fax: 910-353-9003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224L00000X
TaxonomyPedorthist
License NumberCPED0755
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCO003055
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: