Individual
CHARLIE FERGUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2908 MALL DR, FLORENCE, AL 35630-1534
(256) 767-2702
(256) 760-1870
Mailing address
2908 MALL DR, FLORENCE, AL 35630-1534
(256) 767-2702
(256) 760-1870
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
11278
AL
207R00000X
Internal Medicine Physician
Primary
11278
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11278
MEDICAL LICENSE
AL
05
—
3823836
—
TN
01
—
51014730
BLUECROSS BLUE SHIELD
AL
01
—
51083625
BCBS
AL
01
—
930023562
RAILROAD MCR
—
01
—
E368
MEDICARE
AL
Enumeration date
12/16/2005
Last updated
02/06/2020
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