Provider Demographics
NPI:1629056148
Name:FERRY, KRISTIAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIAN
Middle Name:M
Last Name:FERRY
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:PO BOX 1648
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97440-1648
Mailing Address - Country:US
Mailing Address - Phone:541-687-4900
Mailing Address - Fax:541-242-4364
Practice Address - Street 1:360 S GARDEN WAY
Practice Address - Street 2:STE 290
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8173
Practice Address - Country:US
Practice Address - Phone:541-345-2205
Practice Address - Fax:541-345-4480
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22878208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR287410Medicaid
OR287410Medicaid
H36289Medicare UPIN