Provider Demographics
NPI:1982697561
Name:FERRY, ROBERT JEAN JR (MD)
Entity Type:Individual
Prefix:PROF
First Name:ROBERT
Middle Name:JEAN
Last Name:FERRY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15303 HUEBNER RD STE 15
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-0983
Mailing Address - Country:US
Mailing Address - Phone:210-361-3738
Mailing Address - Fax:210-892-3642
Practice Address - Street 1:15303 HUEBNER RD STE 15
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-0983
Practice Address - Country:US
Practice Address - Phone:210-361-3738
Practice Address - Fax:210-892-3642
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8534208000000X, 2080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX031169802Medicaid
TX121696203Medicaid
MS06758520Medicaid
AR168255001Medicaid
TN1505853Medicaid
AR168255001Medicaid
TX031169802Medicaid