MEDICARE: JAMES THOMPSON FERGUSON PA-C

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	363A00000X	Physician Assistant	310	AK
2	363A00000X	Physician Assistant	PA01090	OR

General Provider Information

NPI Number	:	1346447851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES THOMPSON FERGUSON PA-C

Provider Business Mailing Address
First Line	:	PO BOX 3158
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-3158
Country	:	US
Telephone Number	:	503-215-6494
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 N PROVIDENCE DR STE 210
Second Line	:
City	:	NEWBERG
State	:	OR
Zip	:	97132-7582
Country	:	US
Telephone Number	:	503-537-5900
Fax Number	:

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

Provider Enumeration Date	:	06/28/2007
Last Update Date	:	11/29/2021

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