MEDICARE: MR. PHILIP FRANK FERRARA III PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant		NV

General Provider Information

NPI Number	:	1205669264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PHILIP FRANK FERRARA III PA-C

Provider Business Mailing Address
First Line	:	441 N 9TH AVE
Second Line	:
City	:	BOZEMAN
State	:	MT
Zip	:	59715-3329
Country	:	US
Telephone Number	:	770-883-9177
Fax Number	:

Provider Business Practice Location Address
First Line	:	1425 VISTA LN
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89703-4644
Country	:	US
Telephone Number	:	775-445-6680
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2024
Last Update Date	:	08/23/2024

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