Healthcare Provider Details

I. General information

NPI: 1417231929
Provider Name (Legal Business Name): FERRIS FAMILY MEDICINE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2011
Last Update Date: 10/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 W 5TH ST
FERRIS TX
75125-2021
US

IV. Provider business mailing address

207 W 5TH ST
FERRIS TX
75125-2021
US

V. Phone/Fax

Practice location:
  • Phone: 972-842-3016
  • Fax: 972-842-3940
Mailing address:
  • Phone: 972-842-3016
  • Fax: 972-842-3940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateTX

VIII. Authorized Official

Name: MS. BRIDGET E MEGNA
Title or Position: BUSINESS MANAGER
Credential:
Phone: 972-842-3334