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General NPI Number Information
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NPI Number | 1720003700
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Entity Type | Organization
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Legal Business Name | DANIEL FERGUSON, M.D.
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 621 KELLY BLVD
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City | SLIPPERY ROCK
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State | PA
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Zip | 16057-8523
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Country | US
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Telephone | 724-794-4009
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Fax | 724-794-4099
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Provider Business Mailing Address
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Address Line | 621 KELLY BLVD
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City | SLIPPERY ROCK
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State | PA
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Zip | 16057-8523
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Country | US
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Telephone | 724-794-4009
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Fax | 724-794-4099
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DANIEL FERGUSON
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Credential | M.D.
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Telephone | 724-794-4009
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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 | MD040440L
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License Number State | PA
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