Provider Demographics
NPI:1811172620
Name:FEFERMAN, KERY L (MD)
Entity type:Individual
Prefix:
First Name:KERY
Middle Name:L
Last Name:FEFERMAN
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 1:4107 SPICEWOOD SPRINGS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8645
Mailing Address - Country:US
Mailing Address - Phone:512-397-3360
Mailing Address - Fax:123-437-1075
Practice Address - Street 1:4107 SPICEWOOD SPRINGS RD STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8645
Practice Address - Country:US
Practice Address - Phone:512-139-7336
Practice Address - Fax:512-343-7107
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7967207L00000X, 207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204501503Medicaid
TX2045015-08Medicaid
TX204501504Medicaid
TX204501504Medicaid