MEDICARE: MARK ROBERT FERGUSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085P0229X	Pediatric Radiology Physician	337604	LA
2	2085P0229X	Pediatric Radiology Physician	35.147537	OH
3	2085P0229X	Pediatric Radiology Physician	MD00048258	WA

General Provider Information

NPI Number	:	1033228036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK ROBERT FERGUSON MD

Provider Business Mailing Address
First Line	:	2302 N 59TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-5731
Country	:	US
Telephone Number	:	206-683-9889
Fax Number	:

Provider Business Practice Location Address
First Line	:	2302 N 59TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-5731
Country	:	US
Telephone Number	:	206-683-9889
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	08/14/2023

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