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NPI Code Detail

MEDICARE: DAVID MICHAEL FERGUSON M.D.

MEDICARE: DAVID MICHAEL FERGUSON M.D.
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
1207Q00000XFamily Medicine Physician28902AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336169689
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID MICHAEL FERGUSON M.D.
Provider Business Mailing Address
First Line : 500 INDIANA AVE
Second Line :
City : WINSLOW
State : AZ
Zip : 86047-2169
Country : US
Telephone Number : 928-289-4646
Fax Number : 928-289-6289
Provider Business Practice Location Address
First Line : 500 INDIANA AVE
Second Line :
City : WINSLOW
State : AZ
Zip : 86047-2169
Country : US
Telephone Number : 928-289-4646
Fax Number : 928-289-6289
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2006
Last Update Date : 06/04/2015

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