1548581267 NPI number — DR. LARRY PHILLIP FERRELL EDD, LCAS

Table of content: DR. LARRY PHILLIP FERRELL EDD, LCAS (NPI 1548581267)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548581267 NPI number — DR. LARRY PHILLIP FERRELL EDD, LCAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERRELL
Provider First Name:
LARRY
Provider Middle Name:
PHILLIP
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
EDD, LCAS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548581267
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1690 WILMINGTON HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28540-7547
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-938-2003
Provider Business Mailing Address Fax Number:
910-346-6092

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1690 WILMINGTON HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28540-7547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-938-2003
Provider Business Practice Location Address Fax Number:
910-346-6092
Provider Enumeration Date:
06/16/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  1286 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com