Individual
JAY MICHAEL FERGUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3500 TOWER AVE, SUPERIOR, WI 54880-5335
(715) 395-5454
Mailing address
3500 TOWER AVE, SUPERIOR, WI 54880-5335
(715) 395-5454
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1802
WI
363A00000X
Physician Assistant
Primary
9175
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41997800
—
WI
Enumeration date
11/29/2006
Last updated
07/23/2021
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