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General NPI Number Information
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NPI Number | 1801899851
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Entity Type | Individual
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Provider Name | ROBERT E FERRIS M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1241 W STADIUM BLVD
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City | JEFFERSON CITY
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State | MO
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Zip | 65109-6023
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Country | US
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Telephone | 573-556-7717
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Fax | 573-556-1717
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Provider Business Mailing Address
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Address Line | PO BOX 104240
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City | JEFFERSON CITY
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State | MO
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Zip | 65110-4240
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Country | US
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Telephone | 573-556-7717
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Fax | 573-556-1717
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | MD36078
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License Number State | MO
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