Provider Demographics
NPI:1770756835
Name:FERRIS, DONALD WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:WILLIAM
Last Name:FERRIS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 799006 480 ALTA RD
Mailing Address - Street 2:RICHARD J DONOVAN CORRECTIONAL FACILITY MEDICAL DEPT
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92179-9006
Mailing Address - Country:US
Mailing Address - Phone:619-661-6500
Mailing Address - Fax:619-671-7585
Practice Address - Street 1:480 ALTA RD
Practice Address - Street 2:RICHARD J DONOVAN CORRECTIONAL FACILITY MEDICAL DEPT
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92179-9006
Practice Address - Country:US
Practice Address - Phone:619-661-6500
Practice Address - Fax:619-671-7585
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
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Provider Licenses
StateLicense IDTaxonomies
CAG243512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8363018Medicaid
CA8363018Medicaid