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General NPI Number Information
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NPI Number | 1760485494
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Entity Type | Individual
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Provider Name | EARL W FERGUSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/27/2005
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Last Update Date | 12/19/2012
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Provider Practice Location Address
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Address Line | 1081 N CHINA LAKE BLVD
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City | RIDGECREST
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State | CA
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Zip | 93555-3131
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Country | US
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Telephone | 760-499-3000
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Fax | 760-499-3014
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Provider Business Mailing Address
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Address Line | 1539 N CHINA LAKE BLVD # A
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City | RIDGECREST
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State | CA
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Zip | 93555-2606
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Country | US
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Telephone | 760-499-3454
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Fax | 760-446-2254
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | G83290
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License Number State | CA
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