Individual
GAVIN FERGUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1515 E CEDAR AVE STE 2B3B4E12, FLAGSTAFF, AZ 86004-1600
(928) 714-0010
Mailing address
3331 S GILLENWATER DR, FLAGSTAFF, AZ 86005-8983
(928) 600-2185
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
6948
AZ
363AM0700X
Medical Physician Assistant
6948
AZ
Other
Enumeration date
10/17/2017
Last updated
09/21/2023
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