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NPI Code Detail

MEDICARE: KEENAN L FERGUSON D.O.

MEDICARE: KEENAN L FERGUSON D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician4405OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154309466
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEENAN L FERGUSON D.O.
Provider Business Mailing Address
First Line : 900 17TH ST
Second Line :
City : WOODWARD
State : OK
Zip : 73801-2448
Country : US
Telephone Number : 580-596-2800
Fax Number : 580-596-2805
Provider Business Practice Location Address
First Line : 405 S OKLAHOMA AVE
Second Line :
City : CHEROKEE
State : OK
Zip : 73728-2545
Country : US
Telephone Number : 580-596-2800
Fax Number : 580-596-2805
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2006
Last Update Date : 04/24/2018

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Directions to “ KEENAN L FERGUSON D.O.” Practice Location

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