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General NPI Number Information
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NPI Number | 1043666191
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Entity Type | Individual
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Provider Name | ETHAN L FERGUSON MD
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Gender | Male
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Dates
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Enumeration Date | 05/08/2016
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 1801 N SENATE BLVD SUITE 220
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City | INDIANAPOLIS
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State | IN
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Zip | 46202
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Country | US
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Telephone | 317-962-3700
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Fax | 317-962-2893
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Provider Business Mailing Address
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Address Line | 1801 N SENATE BLVD STE 220
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-1260
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Country | US
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Telephone | 317-962-3700
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Fax | 317-962-2893
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 35.142317
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 01090971A
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License Number State | IN
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