Provider Demographics
NPI:1568476125
Name:FERRON, FREDERICK RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:RICHARD
Last Name:FERRON
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 1:200 WESTERN AVENUE
Mailing Address - Street 2:
Mailing Address - City:FAIRBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-3504
Mailing Address - Country:US
Mailing Address - Phone:507-333-2028
Mailing Address - Fax:
Practice Address - Street 1:200 WESTERN AVENUE
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021
Practice Address - Country:US
Practice Address - Phone:507-333-2028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN560588100Medicaid
MNA95579Medicare UPIN
MN260001784Medicare ID - Type Unspecified