Provider Demographics
NPI:1568696243
Name:FERENZ, GREGORY J (DO)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:J
Last Name:FERENZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 NW KINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-2136
Mailing Address - Country:US
Mailing Address - Phone:215-850-7311
Mailing Address - Fax:303-682-2785
Practice Address - Street 1:1511 ONYX CIR
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80504-7805
Practice Address - Country:US
Practice Address - Phone:440-934-6135
Practice Address - Fax:440-937-6147
Is Sole Proprietor?:No
Enumeration Date:2009-05-08
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT0123882084N0400X
CODR.00569572084N0600X
ORDO1623672084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500659636Medicaid
ORP01255924OtherMEDICARE RAILROAD
ORP01255924OtherMEDICARE RAILROAD