MEDICARE: TIMOTHY J FERGUSON M.D.

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
1	207Q00000X	Family Medicine Physician	A036813	CA

Other Identifiers

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

General Provider Information

NPI Number	:	1205878451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY J FERGUSON M.D.

Provider Business Mailing Address
First Line	:	210 S GRAND AVE
Second Line	:	GLENDORA
City	:	GLENDORA
State	:	CA
Zip	:	91741-4205
Country	:	US
Telephone Number	:	626-335-3527
Fax Number	:	626-963-7972

Provider Business Practice Location Address
First Line	:	210 S. GRAND
Second Line	:	GLENDORA
City	:	GLENDORA
State	:	CA
Zip	:	91741-4205
Country	:	US
Telephone Number	:	626-963-9402
Fax Number	:	626-914-5316

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	09/10/2008

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