Individual
DR. DIANE A FERGUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2085 GOODMAN RD W, SUITE 50, HORN LAKE, MS 38637-1416
(662) 253-8459
(662) 253-8678
Mailing address
2085 GOODMAN RD W, SUITE 50, HORN LAKE, MS 38637-1416
(662) 253-8459
(662) 253-8678
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
10806
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0111871
—
MS
Enumeration date
10/02/2006
Last updated
05/04/2016
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