Provider Demographics
NPI:1184699654
Name:FERREE, E SCOTT (DO)
Entity type:Individual
Prefix:
First Name:E
Middle Name:SCOTT
Last Name:FERREE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:SCOTT
Other - Middle Name:
Other - Last Name:FERREE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:4021 ROTHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-7919
Mailing Address - Country:US
Mailing Address - Phone:817-731-6121
Mailing Address - Fax:817-732-8015
Practice Address - Street 1:4021 ROTHINGTON RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-7919
Practice Address - Country:US
Practice Address - Phone:817-731-6121
Practice Address - Fax:817-732-8015
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-20
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9267207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096566703Medicaid
TX096566702Medicaid
110213835OtherMEDICARE RAILROAD
TX0044GGOtherBCBS
TX8CF372OtherBCBS
TX8F23935Medicare PIN
110213835OtherMEDICARE RAILROAD
H27574Medicare UPIN