Healthcare Provider Details

I. General information

NPI: 1538063649
Provider Name (Legal Business Name): CHARLES EDGAR FERGUSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 888
BASTROP TX
78602-0888
US

IV. Provider business mailing address

PO BOX 888
BASTROP TX
78602-0888
US

V. Phone/Fax

Practice location:
  • Phone: 512-618-9708
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number746185
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: