Individual
DR. ANGELA GREMILLION FERGUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
9812 SLIDE RD, LUBBOCK, TX 79424-5781
(806) 725-8765
(806) 725-8758
Mailing address
3420 22ND PL, LUBBOCK, TX 79410-1314
(806) 725-5844
(806) 723-6532
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A-1661-12
NM
207R00000X
Internal Medicine Physician
Primary
P7436
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
326015001
—
TX
05
—
83308539
—
NM
01
—
8DY748
BCBS TX
TX
01
—
960091100
FIRSTCARE
TX
Enumeration date
03/09/2009
Last updated
10/16/2015
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