Individual
DR. BLAISE EDWARD FERRARACCIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4848 NE STALLINGS DR STE 106, NACOGDOCHES, TX 75965-1256
(936) 559-9510
(936) 559-9598
Mailing address
4848 NE STALLINGS DR STE 106, NACOGDOCHES, TX 75965-1256
(936) 559-9510
(936) 559-9598
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
L8055
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
162235901
—
TX
Enumeration date
04/25/2006
Last updated
12/08/2021
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