Provider Demographics
NPI:1255762605
Name:CAROLINE G FERRIS PLLC
Entity type:Organization
Organization Name:CAROLINE G FERRIS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:GREER
Authorized Official - Last Name:FERRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-623-7533
Mailing Address - Street 1:2409 PISTACHIO DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3453
Mailing Address - Country:US
Mailing Address - Phone:972-623-7533
Mailing Address - Fax:
Practice Address - Street 1:2409 PISTACHIO DR
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3453
Practice Address - Country:US
Practice Address - Phone:972-623-7533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-11
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4777207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181298403Medicaid
TXH78443Medicare UPIN
8J4110Medicare PIN