Basic Information
| Provider Information | |||||||||
| NPI: | 1861496614 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FERRIS | ||||||||
| FirstName: | FRED | ||||||||
| MiddleName: | Z | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4127 | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5409819394 | ||||||||
| FaxNumber: | 5403447154 | ||||||||
| Practice Location | |||||||||
| Address1: | 2900 LAMB CIRCLE | ||||||||
| Address2: | SUITE 190, BLUE RIDGE NEPHROLOGY ASSOCIATES PC | ||||||||
| City: | CHRISTIANSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240736344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5406335650 | ||||||||
| FaxNumber: | 5406335659 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2005 | ||||||||
| LastUpdateDate: | 04/12/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 16546 | N | Other Service Providers | Specialist | 207RN0300X | 0101246737 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 81031 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER |