Provider Demographics
NPI:1811216120
Name:EDWIN L. FERREN, M.D. PA
Entity Type:Organization
Organization Name:EDWIN L. FERREN, M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:FERREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-564-2401
Mailing Address - Street 1:PO BOX 631068
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75963-1068
Mailing Address - Country:US
Mailing Address - Phone:936-564-2401
Mailing Address - Fax:936-560-0295
Practice Address - Street 1:1023 N MOUND ST
Practice Address - Street 2:SUITE E
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4491
Practice Address - Country:US
Practice Address - Phone:936-564-2401
Practice Address - Fax:936-560-0295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5038207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123075704Medicaid
TX123075704Medicaid
TX00G14WMedicare PIN