Provider Demographics
NPI:1801933205
Name:FERRILL, SHELLEY C (MD)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:C
Last Name:FERRILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23144 WESTHEIMER PARKWAY
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-3603
Mailing Address - Country:US
Mailing Address - Phone:281-392-5005
Mailing Address - Fax:281-392-5052
Practice Address - Street 1:23144 WESTHEIMER PARKWAY
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-3603
Practice Address - Country:US
Practice Address - Phone:281-392-5005
Practice Address - Fax:281-392-5052
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2247207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8R1740OtherBLUE CROSS INDIVIDUAL NUM
TX7876395OtherAETNA PROVIDER NUMBER
TX7876395OtherAETNA PROVIDER NUMBER
TX8R1740OtherBLUE CROSS INDIVIDUAL NUM