Individual
DR. HOMER ASHTON FERGUSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3990 N ILLINOIS ST, SWANSEA, IL 62226-1919
(618) 277-1130
(618) 277-4917
Mailing address
3990 N ILLINOIS ST, SWANSEA, IL 62226-1919
(618) 277-1130
(618) 277-4917
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1790728012
NPI GROUP
IL
Enumeration date
06/16/2005
Last updated
11/20/2007
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