Provider Demographics
NPI:1518096288
Name:FERRELL, MICHAEL SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SCOTT
Last Name:FERRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4281 N RIVER GROVE CIR
Mailing Address - Street 2:#219
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-1170
Mailing Address - Country:US
Mailing Address - Phone:520-906-6399
Mailing Address - Fax:520-879-6099
Practice Address - Street 1:7490 S CAMINO DE OESTE
Practice Address - Street 2:CSBEHAVIORAL HEALTH DEPARTMENT
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85746-9308
Practice Address - Country:US
Practice Address - Phone:520-879-6060
Practice Address - Fax:520-879-6099
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ288892084P0800X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ218075Medicaid
AZ395174OtherADHS
AZ553869Medicaid