Healthcare Provider Details

I. General information

NPI: 1881663409
Provider Name (Legal Business Name): MICHAEL E FERGUSON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 02/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 N BELKNAP ST
STEPHENVILLE TX
76401-3415
US

IV. Provider business mailing address

PO BOX 1558
STEPHENVILLE TX
76401-0030
US

V. Phone/Fax

Practice location:
  • Phone: 254-965-2663
  • Fax:
Mailing address:
  • Phone: 254-965-2663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number239345
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: