Healthcare Provider Details

I. General information

NPI: 1225092265
Provider Name (Legal Business Name): ROBERT J FERRALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 LAKE DAM RD # 37421
RALEIGH NC
27606-4240
US

IV. Provider business mailing address

PO BOX 37421
RALEIGH NC
27627-7421
US

V. Phone/Fax

Practice location:
  • Phone: 999-999-9999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number9500574
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9500574
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: