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General NPI Number Information
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NPI Number | 1467563460
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Entity Type | Individual
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Provider Name | TIMMY ALAN FERRELL MD
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 05/15/2024
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Provider Practice Location Address
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Address Line | 5325 FARAON ST
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City | SAINT JOSEPH
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State | MO
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Zip | 64506-3488
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Country | US
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Telephone | 816-271-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 10520 N PAYMENT PEAK RD
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City | HAUSER
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State | ID
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Zip | 83854-4524
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Country | US
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Telephone | 208-619-9334
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | M12915
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 2017039277
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License Number State | MO
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