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General NPI Number Information
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NPI Number | 1003842071
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Entity Type | Individual
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Provider Name | WILLIAM BONLORE FERGUSON PHD, MD
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Gender | Male
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 02/19/2009
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Provider Practice Location Address
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Address Line | 61 MEMORIAL MEDICAL PKWY SUITE 3806
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City | PALM COAST
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State | FL
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Zip | 32164-5981
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Country | US
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Telephone | 386-437-7340
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Fax | 386-437-7341
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Provider Business Mailing Address
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Address Line | 61 MEMORIAL MEDICAL PKWY SUITE 3806
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City | PALM COAST
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State | FL
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Zip | 32164-5981
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Country | US
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Telephone | 386-437-7340
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Fax | 386-437-7341
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | ME94793
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License Number State | FL
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