Provider Demographics
NPI:1013962919
Name:FERRIE, DEREK J (MD)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:J
Last Name:FERRIE
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 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2100 HIGHLAND WAY
Practice Address - Street 2:STE K
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-6409
Practice Address - Country:US
Practice Address - Phone:605-996-0400
Practice Address - Fax:605-996-0401
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4729207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6003822Medicaid
SD0008100OtherBCBS
SD6003822Medicaid
SD0008100OtherBCBS
SDS8100Medicare PIN