Healthcare Provider Details

I. General information

NPI: 1194093146
Provider Name (Legal Business Name): JOHN DAVID FERRIN D.M.D. , MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2011
Last Update Date: 06/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 E BARNETT RD
MEDFORD OR
97504-8309
US

IV. Provider business mailing address

2930 E BARNETT RD
MEDFORD OR
97504-8309
US

V. Phone/Fax

Practice location:
  • Phone: 541-944-5745
  • Fax:
Mailing address:
  • Phone: 541-944-5745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number10048
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: