Healthcare Provider Details

I. General information

NPI: 1144460544
Provider Name (Legal Business Name): JAMES LEE FERGUSON JR. D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2009
Last Update Date: 04/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HIGHPOINT DR SUITE 102
CHALFONT PA
18914-3926
US

IV. Provider business mailing address

100 HIGHPOINT DR SUITE 102
CHALFONT PA
18914-3926
US

V. Phone/Fax

Practice location:
  • Phone: 800-732-3784
  • Fax:
Mailing address:
  • Phone: 800-732-3784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberH0048258
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: