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General NPI Number Information
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NPI Number | 1619068681
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Entity Type | Individual
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Provider Name | CARL EDWARD FERGUSON D.O.
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Gender | Male
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 3514 N POWER RD STE 105
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City | MESA
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State | AZ
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Zip | 85215-2907
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Country | US
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Telephone | 480-422-8533
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Fax | 480-981-2442
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Provider Business Mailing Address
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Address Line | 7529 E BASELINE SUITE 101
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City | MESA
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State | AZ
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Zip | 85208
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Country | US
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Telephone | 480-945-4343
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Fax | 480-945-4350
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2244
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License Number State | AZ
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