Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 0414427 | KS |
N | 208600000X | Surgeon | 0414427 | KS |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 04-14427 | KS |
NPI | 1255380366 |
---|---|
Provider Name | Dr. Bruce G. Ferris |
First Address | Wichita, KS 67206-3413 |
Second Address | Wichita, KS 67206-3413 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 04/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1000093110B | (05) | KS |
101568 | BCBS# (01) | KS |
B69076 | (02) | KS |