MEDICARE: MR. JASON LINDSEY FERRIS 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	103281	NC

General Provider Information

NPI Number	:	1528062940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JASON LINDSEY FERRIS PA-C

Provider Business Mailing Address
First Line	:	PO BOX 1267
Second Line	:
City	:	MOUNT AIRY
State	:	NC
Zip	:	27030-1267
Country	:	US
Telephone Number	:	336-786-4522
Fax Number	:	336-789-3025

Provider Business Practice Location Address
First Line	:	314 S SOUTH ST STE 100
Second Line	:
City	:	MOUNT AIRY
State	:	NC
Zip	:	27030
Country	:	US
Telephone Number	:	336-719-0011
Fax Number	:	336-719-0714

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	08/15/2018

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