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General NPI Number Information
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NPI Number | 1487676292
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Entity Type | Individual
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Provider Name | DOUGLAS BISMARK FERGUSON MD
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Gender | Male
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 10/11/2013
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Provider Practice Location Address
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Address Line | 3500 I-30
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City | MESQUITE
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State | TX
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Zip | 75185-1672
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Country | US
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Telephone | 972-698-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 202 CYPRESS CT
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City | WACO
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State | TX
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Zip | 76712-7555
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Country | US
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Telephone | 254-723-7784
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | G3353
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License Number State | TX
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