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General NPI Number Information
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NPI Number | 1093756678
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Entity Type | Individual
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Provider Name | SUSAN CALLAWAY FERGUSON MD
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Gender | Female
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 03/04/2014
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Provider Practice Location Address
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Address Line | 616 16TH ST
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City | OAKLAND
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State | CA
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Zip | 94612
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Country | US
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Telephone | 510-451-4270
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Fax | 510-451-4285
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Provider Business Mailing Address
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Address Line | 616 16TH ST
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City | OAKLAND CA
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State | CA
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Zip | 94612
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Country | US
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Telephone | 510-451-4270
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Fax | 510-451-4285
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A68471
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | A68471
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License Number State | CA
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