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Individual
STANLEY R FERGUSON
Active
Individual
STANLEY R FERGUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA00220
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110047682
RR MEDICARE
OR
Enumeration date
11/01/2006
Last updated
09/20/2010
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