Healthcare Provider Details

I. General information

NPI: 1790785038
Provider Name (Legal Business Name): RONALD FERGISON P.A.-C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 E ASH AVE
BUCKEYE AZ
85326-2205
US

IV. Provider business mailing address

1315 E ASH AVE
BUCKEYE AZ
85326-2205
US

V. Phone/Fax

Practice location:
  • Phone: 623-386-4011
  • Fax:
Mailing address:
  • Phone: 623-386-4011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1072
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: