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General NPI Number Information
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NPI Number | 1659486587
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Entity Type | Individual
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Provider Name | JOHN J FERGUSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 01/03/2014
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Provider Practice Location Address
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Address Line | 10060 REGENCY CIR
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City | OMAHA
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State | NE
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Zip | 68114-3732
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Country | US
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Telephone | 402-354-1315
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Fax | 402-354-1309
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Provider Business Mailing Address
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Address Line | PO BOX 3755
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City | OMAHA
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State | NE
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Zip | 68103-0755
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Country | US
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Telephone | 402-354-2100
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Fax | 402-354-2155
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 12664
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 21857
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License Number State | IA
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