Provider Demographics
NPI:1952466328
Name:FERRIS, ROBERTO ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:ANTONIO
Last Name:FERRIS
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:LIRO ST 211 CIUDAD JARDIN
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00000-0987
Mailing Address - Country:US
Mailing Address - Phone:787-876-5266
Mailing Address - Fax:787-256-1775
Practice Address - Street 1:211 CALLE LIRIO
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-2213
Practice Address - Country:US
Practice Address - Phone:787-876-5266
Practice Address - Fax:787-256-1775
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10927208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG06807Medicare UPIN
PR0083257Medicare ID - Type Unspecified