Individual
JACKSON FERGUSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1455 MAIN ST STE 100, WINDSOR, CO 80550-5559
(970) 686-3950
(970) 686-3960
Mailing address
1455 MAIN ST STE 100, WINDSOR, CO 80550-5559
(970) 686-3950
(970) 686-3960
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.0004074
CO
363AM0700X
Medical Physician Assistant
PA165403
OR
Other
Enumeration date
02/07/2012
Last updated
07/23/2021
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