MEDICARE: MR. FRED Z FERRIS MD

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	174400000X	Specialist	16546
2	207RN0300X	Nephrology Physician	0101246737	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	81031	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1861496614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FRED Z FERRIS MD

Provider Business Mailing Address
First Line	:	PO BOX 4127
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24015
Country	:	US
Telephone Number	:	540-981-9394
Fax Number	:	540-344-7154

Provider Business Practice Location Address
First Line	:	2900 LAMB CIRCLE
Second Line	:	SUITE 190, BLUE RIDGE NEPHROLOGY ASSOCIATES PC
City	:	CHRISTIANSBURG
State	:	VA
Zip	:	24073-6344
Country	:	US
Telephone Number	:	540-633-5650
Fax Number	:	540-633-5659

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	04/12/2011

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