Provider Demographics
NPI:1073596094
Name:FERRARA, GREGORY F (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:F
Last Name:FERRARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13828 COURSEY BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-1307
Mailing Address - Country:US
Mailing Address - Phone:225-752-4530
Mailing Address - Fax:225-752-4652
Practice Address - Street 1:13828 COURSEY BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-1307
Practice Address - Country:US
Practice Address - Phone:225-751-1544
Practice Address - Fax:225-751-1909
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA015137207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA51185CK50Medicare PIN
LAB62865Medicare UPIN
LA51185CK50Medicare ID - Type Unspecified