Healthcare Provider Details

I. General information

NPI: 1508506759
Provider Name (Legal Business Name): ROBERT FERGUSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8620 SPRING CYPRESS RD
SPRING TX
77379-3316
US

IV. Provider business mailing address

14131 MIDWAY RD STE 800
ADDISON TX
75001-3627
US

V. Phone/Fax

Practice location:
  • Phone: 832-791-1214
  • Fax:
Mailing address:
  • Phone: 855-782-7822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: