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Individual

MR. BENJAMIN FERGUSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA

Contact information

Practice address
2850 SE POWELL VALLEY RD, GRESHAM, OR 97080-1494
(503) 666-5050
(503) 666-1162
Mailing address
305 SE CHKALOV DR, STE 170, VANCOUVER, WA 98683-5263
(803) 435-8463
(803) 435-5288

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
01623
WV
363A00000X
Physician Assistant
Primary
7803
AZ
363AM0700X
Medical Physician Assistant
1844

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1844
LICENSE
SC
01
PA181079
LICENSE
OR
Enumeration date
03/06/2012
Last updated
02/08/2021
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