Provider Demographics
NPI:1447244454
Name:FERIA, MARY IRENE B (MD)
Entity Type:Individual
Prefix:
First Name:MARY IRENE
Middle Name:B
Last Name:FERIA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:430 WINDWARD WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2619
Mailing Address - Country:US
Mailing Address - Phone:406-751-5364
Mailing Address - Fax:406-751-5367
Practice Address - Street 1:430 WINDWARD WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-2619
Practice Address - Country:US
Practice Address - Phone:406-751-5364
Practice Address - Fax:406-751-5367
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2024-02-19
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Provider Licenses
StateLicense IDTaxonomies
WAMD60147278207K00000X
IL036-108978207R00000X
IA34363207R00000X
MT41983207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1447244454Medicaid
WA1447244454Medicaid