MEDICARE: MR. JAMES GORDON FERRELL BC-HIS

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	237700000X	Hearing Instrument Specialist	2813	PA

General Provider Information

NPI Number	:	1699818336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES GORDON FERRELL BC-HIS

Provider Business Mailing Address
First Line	:	4934 PEACH ST
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16509-2043
Country	:	US
Telephone Number	:	814-868-5487
Fax Number	:	814-868-7518

Provider Business Practice Location Address
First Line	:	4934 PEACH ST
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16509-2043
Country	:	US
Telephone Number	:	814-868-5487
Fax Number	:	814-868-7518

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

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	07/08/2007

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