Individual
DR. KEITH TIMOTHY FERGUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3660 VISTA AVE, SAINT LOUIS, MO 63110-2540
(314) 977-6100
(314) 977-6164
Mailing address
3635 VISTA AVE FL 7, SAINT LOUIS, MO 63110-2539
(314) 577-8856
(314) 577-8859
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
036140072
IL
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
2020013186
MO
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
61842-20
WI
207RP1001X
Pulmonary Disease Physician
036140072
IL
207RP1001X
Pulmonary Disease Physician
Primary
2020013186
MO
207RP1001X
Pulmonary Disease Physician
61842-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861758526
—
WI
Enumeration date
04/06/2012
Last updated
06/22/2020
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