Provider Demographics
NPI:1184808552
Name:WILLIAM FERMAN MD PS
Entity type:Organization
Organization Name:WILLIAM FERMAN MD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-373-0200
Mailing Address - Street 1:2528 WHEATON WAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3305
Mailing Address - Country:US
Mailing Address - Phone:360-373-0200
Mailing Address - Fax:360-373-0425
Practice Address - Street 1:2528 WHEATON WAY
Practice Address - Street 2:SUITE 103
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310
Practice Address - Country:US
Practice Address - Phone:360-373-0200
Practice Address - Fax:360-373-0425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00026366207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7067655Medicaid
WA7067655Medicaid