Individual
OTIS B FERGUSON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7633 E JEFFERSON, STE 120, DETROIT, MI 48214-3730
(313) 824-8941
(313) 824-1115
Mailing address
7633 E JEFFERSON, STE 120, DETROIT, MI 48214-3730
(313) 824-8941
(313) 824-1115
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
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