# JOHN D FERRIS PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124153986
- **Authorized official:** JOHN D FERRIS MD (OWNER)
- **Authorized official phone:** (307) 856-0009

## Contact information

- **Practice address:** 300 N BROADWAY AVE, RIVERTON, WY 82501-3545
- **Practice address phone:** (307) 856-0009
- **Mailing address:** 300 N BROADWAY AVE, RIVERTON, WY 82501-3545
- **Mailing address phone:** (307) 856-0009

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | 2139A | WY | Yes |

## Other

- **Enumeration date:** 02/22/2007
- **Last updated:** 08/21/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0000563350 | BC BS OF KS | KS |
| 01 | — | 010062665 | RAILROAD MEDICARE | WY |
| 05 | — | 108971400 | — | WY |
| 05 | — | 89334841 | — | CO |
| 05 | — | 91021394 | — | CO |