Provider Demographics
NPI:1023098027
Name:ENDSLEY, FERRAL L (DO)
Entity type:Individual
Prefix:
First Name:FERRAL
Middle Name:L
Last Name:ENDSLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1934 HICKORY ST
Mailing Address - Street 2:STE 100
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2336
Mailing Address - Country:US
Mailing Address - Phone:325-670-5300
Mailing Address - Fax:325-670-5305
Practice Address - Street 1:1934 HICKORY ST
Practice Address - Street 2:STE 100
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2336
Practice Address - Country:US
Practice Address - Phone:325-670-5300
Practice Address - Fax:325-670-5305
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3381208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030999901Medicaid
0072AYMedicare ID - Type Unspecified
C15464Medicare UPIN