Provider Demographics
NPI:1245255629
Name:FERRIS, MARK CHARLES (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:CHARLES
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:PO BOX 1457
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75461-1457
Mailing Address - Country:US
Mailing Address - Phone:903-737-1680
Mailing Address - Fax:
Practice Address - Street 1:2850 LEWIS LN STE 109
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-9378
Practice Address - Country:US
Practice Address - Phone:903-737-1680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2020-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5758207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115596203Medicaid
TX290012186OtherRAILROAD MEDICARE
TX290012186OtherRAILROAD MEDICARE
TX115596203Medicaid