Provider Demographics
NPI:1477552073
Name:FERRARA, CRAIG A (DO)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:A
Last Name:FERRARA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:220 W. COLORADO BLVD #625
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208
Mailing Address - Country:US
Mailing Address - Phone:214-946-5165
Mailing Address - Fax:214-946-4876
Practice Address - Street 1:2801 BOLTON BOONE DRIVE #105
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115
Practice Address - Country:US
Practice Address - Phone:972-296-2122
Practice Address - Fax:972-296-2522
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL10352086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142046501Medicaid
OKP00477283OtherMEDICARE PIN