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Individual
ETHAN L FERGUSON
Active
Individual
ETHAN L FERGUSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
01090971A
IN
208800000X
Urology Physician
35.142317
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1102510313
ANTHEM PTAN
IN
05
—
300078672
—
IN
Enumeration date
05/08/2016
Last updated
03/07/2025
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