Individual
JORDAN BLAKE FERGUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
705 RILEY HOSPITAL DR, INDIANAPOLIS, IN 46202-5109
(317) 944-5000
(317) 963-5492
Mailing address
705 RILEY HOSPITAL DR, INDIANAPOLIS, IN 46202-5109
(317) 944-5000
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
02007657A
IN
208000000X
Pediatrics Physician
34.014921
OH
208000000X
Pediatrics Physician
DO-05346
IA
208000000X
Pediatrics Physician
R-10953
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1101473792
ANTHEM PTAN
IN
05
—
300090157
—
IN
Enumeration date
06/02/2017
Last updated
03/07/2025
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