Provider Demographics
NPI:1104872662
Name:FERRIS, VIJAY (MD)
Entity type:Individual
Prefix:
First Name:VIJAY
Middle Name:
Last Name:FERRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38056 DAUGHTERY RD
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33540-1375
Mailing Address - Country:US
Mailing Address - Phone:813-782-5801
Mailing Address - Fax:813-782-5732
Practice Address - Street 1:38056 DAUGHTERY RD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33540-1375
Practice Address - Country:US
Practice Address - Phone:813-782-5801
Practice Address - Fax:813-782-5732
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61884208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374746800Medicaid
FL374746800Medicaid
FL23550Medicare ID - Type Unspecified