Provider Demographics
NPI:1396364394
Name:FERRISE, THOMAS DANIEL (DPM)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:DANIEL
Last Name:FERRISE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 COLLEGE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3051
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:923 COLLEGE AVE STE 101
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3051
Practice Address - Country:US
Practice Address - Phone:817-697-4038
Practice Address - Fax:877-409-3962
Is Sole Proprietor?:No
Enumeration Date:2020-04-10
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX692116213ES0103X
CAE5949213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery