Individual
DR. JILL ANNE FERGUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2915 MISSOURI AVE, SHREVEPORT, LA 71109-4327
(318) 621-8820
(318) 212-4189
Mailing address
PO BOX 731280, DALLAS, TX 75373-1280
(318) 841-9526
(318) 841-9551
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
11013817A
IN
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
205414
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12373627
CAQH PROVIDER ID
LA
05
—
2302086
—
LA
01
—
MD.205414
LA - STATE LICENSE MD
LA
01
—
P01099769
RR MEDICARE
LA
Enumeration date
06/12/2008
Last updated
06/22/2016
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