Provider Demographics
NPI:1417264250
Name:FERRARI, JONATHAN P (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:P
Last Name:FERRARI
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 1:2713 S 74TH ST STE 401
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-5173
Mailing Address - Country:US
Mailing Address - Phone:479-573-3101
Mailing Address - Fax:479-573-3102
Practice Address - Street 1:2713 S 74TH ST STE 401
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5173
Practice Address - Country:US
Practice Address - Phone:479-573-3101
Practice Address - Fax:479-573-3102
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-9253208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH390200000XOtherHUMILTY OF MARY HEALTH PARTNERS