Individual
STANLEY R FERGUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Contact information
Practice address
775 SW 9TH ST, SUITE B, NEWPORT, OR 97365-4895
(541) 265-2007
(541) 265-3533
Mailing address
775 SW 9TH ST, SUITE B, NEWPORT, OR 97365-4895
(541) 265-2007
(541) 265-3533
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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