Provider Demographics
NPI:1366447419
Name:FERREN, EDWIN L
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:L
Last Name:FERREN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3816 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-2011
Mailing Address - Country:US
Mailing Address - Phone:936-560-2990
Mailing Address - Fax:936-560-3609
Practice Address - Street 1:3816 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-2011
Practice Address - Country:US
Practice Address - Phone:936-560-2990
Practice Address - Fax:936-560-3609
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5038207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123075704Medicaid
TX2222690OtherBLUE LINK
TX00G14WMedicare ID - Type Unspecified
TXB22690Medicare UPIN
TX0609040001Medicare NSC