Provider Demographics
NPI:1043412075
Name:DONALD L FERRIS DPM PC
Entity Type:Organization
Organization Name:DONALD L FERRIS DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FERRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:423-764-8741
Mailing Address - Street 1:350 BLOUNTVILLE HWY
Mailing Address - Street 2:STE 103
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-1676
Mailing Address - Country:US
Mailing Address - Phone:423-764-8741
Mailing Address - Fax:
Practice Address - Street 1:350 BLOUNTVILLE HWY
Practice Address - Street 2:STE 103
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-1676
Practice Address - Country:US
Practice Address - Phone:423-764-8741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0080963213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3350812Medicare ID - Type Unspecified