Healthcare Provider Details

I. General information

NPI: 1679082523
Provider Name (Legal Business Name): CHRISTOPHER WAYNE FERGUSON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2017
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 E. OSBORN RD. STE 150
PHOENIX AZ
85012
US

IV. Provider business mailing address

77 E THOMAS RD STE 230
PHOENIX AZ
85012-3100
US

V. Phone/Fax

Practice location:
  • Phone: 602-264-4431
  • Fax: 602-266-3870
Mailing address:
  • Phone: 602-557-0007
  • Fax: 602-557-0001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6874
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: