Provider Demographics
NPI:1700079605
Name:GREGORY S. FERRISS, M.D., LLC
Entity type:Organization
Organization Name:GREGORY S. FERRISS, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:S
Authorized Official - Last Name:FERRISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-897-4420
Mailing Address - Street 1:4429 CLARA ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-6902
Mailing Address - Country:US
Mailing Address - Phone:504-897-4420
Mailing Address - Fax:504-897-4421
Practice Address - Street 1:4429 CLARA ST
Practice Address - Street 2:SUITE 500
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-6902
Practice Address - Country:US
Practice Address - Phone:504-897-4420
Practice Address - Fax:504-897-4421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0065202084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1036510Medicaid
LA5CR09Medicare PIN
LA5J364CR09Medicare PIN
LA1036510Medicaid