Provider Demographics
NPI:1720222631
Name:SCOTT S. FERER, M.D., A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SCOTT S. FERER, M.D., A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE CONSULTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HUNNICUTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-258-0011
Mailing Address - Street 1:2216 NEWPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-1711
Mailing Address - Country:US
Mailing Address - Phone:714-258-0011
Mailing Address - Fax:714-258-0154
Practice Address - Street 1:2216 NEWPORT BLVD
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-1711
Practice Address - Country:US
Practice Address - Phone:714-258-0011
Practice Address - Fax:714-258-0154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG759542084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG75954OtherCALIFORNIA STATE MEDICAL LICENSE NUMBER
CAG75954OtherCALIFORNIA STATE MEDICAL LICENSE NUMBER