Healthcare Provider Details

I. General information

NPI: 1366401176
Provider Name (Legal Business Name): MARY TROY FERGUSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: M. TROY FERGUSON MD

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 02/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 MILL ST
RENO NV
89502-1576
US

IV. Provider business mailing address

748 S MEADOWS PKWY A9-336
RENO NV
89521-3861
US

V. Phone/Fax

Practice location:
  • Phone: 775-982-4100
  • Fax:
Mailing address:
  • Phone: 775-324-4040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number9940
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number65017-20
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number9940
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD2015-0932
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number04-38648
License Number StateKS
# 6
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number51546
License Number StateAZ
# 7
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number60048
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: