Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 1112696 | OK |
NPI | 1215905591 |
---|---|
Provider Name | John A Ferris |
First Address | Stilwell, OK 74960-0272 |
Second Address | Stilwell, OK 74960-3217 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2006 |
Last Update Date | 06/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200062440A | (05) | OK |
A26657 | (02) |