Individual
OTIS B FERGUSON III
Active
Individual
OTIS B FERGUSON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
4301064409
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000002337
CAPE HEALTH PLAN
—
01
—
1004844002
WELLNESS PLAN
—
01
—
117351
CARE CHOICES
—
01
—
1808205190
BCBS
—
01
—
48637
OMNICARE
—
01
—
5285466
AETNA
—
01
—
G12616
HAP
—
Enumeration date
10/31/2006
Last updated
03/11/2008
Update your record
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