Provider Demographics
NPI:1215923313
Name:FERRO, GREGORY MATTHEW (DO)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:MATTHEW
Last Name:FERRO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1832 PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46613-1400
Mailing Address - Country:US
Mailing Address - Phone:574-287-5712
Mailing Address - Fax:574-289-2763
Practice Address - Street 1:1832 PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46613-1400
Practice Address - Country:US
Practice Address - Phone:574-287-5712
Practice Address - Fax:574-289-2763
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02000365A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E33577Medicare UPIN
727890Medicare ID - Type Unspecified