Healthcare Provider Details

I. General information

NPI: 1134120165
Provider Name (Legal Business Name): JOHN J FERRY MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2005
Last Update Date: 02/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7205 W CENTER RD SUITE 100
OMAHA NE
68124
US

IV. Provider business mailing address

7205 W CENTER RD SUITE 100
OMAHA NE
68124
US

V. Phone/Fax

Practice location:
  • Phone: 402-926-2425
  • Fax: 402-926-2435
Mailing address:
  • Phone: 402-926-2425
  • Fax: 402-926-2435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number19695
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number11256
License Number StateNE

VIII. Authorized Official

Name: JOHN J FERRY
Title or Position: PRESIDENT
Credential: MD
Phone: 402-926-2425