Provider Demographics
NPI:1255466348
Name:MCFERRON, GARY M (CO, CPED)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:M
Last Name:MCFERRON
Suffix:
Gender:M
Credentials:CO, CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-7325
Mailing Address - Country:US
Mailing Address - Phone:910-353-9002
Mailing Address - Fax:910-353-9003
Practice Address - Street 1:12 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-7325
Practice Address - Country:US
Practice Address - Phone:103-539-0029
Practice Address - Fax:910-353-9003
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CPED0755224L00000X
225000000X
NCCO003055222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC047H3OtherBCBS
NC5980950001Medicare NSC
NC5980950002Medicare NSC