Individual
DR. C. GLEN FERGUSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1615 BONFORTE BLVD, PUEBLO, CO 81001-1602
(719) 296-5840
(719) 542-0746
Mailing address
1615 BONFORTE BLVD, PUEBLO, CO 81001-1602
(719) 296-5840
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
17205
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01172055
—
CO
01
—
17205
COLORADO STATE LICENSE
CO
05
—
94559040
—
CO
01
—
FE03792
BCBS
—
Enumeration date
09/22/2006
Last updated
03/07/2023
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