MEDICARE: ZACHARY L FERGUSON PA

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	2019003623	MO
2	207N00000X	Dermatology Physician	2019003623	MO

General Provider Information

NPI Number	:	1376008334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZACHARY L FERGUSON PA

Provider Business Mailing Address
First Line	:	1460 VICTORIA RD
Second Line	:
City	:	POPLAR BLUFF
State	:	MO
Zip	:	63901-9233
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 PHYSICIANS PARK
Second Line	:
City	:	POPLAR BLUFF
State	:	MO
Zip	:	63901-3935
Country	:	US
Telephone Number	:	573-686-4750
Fax Number	:

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

Provider Enumeration Date	:	02/04/2019
Last Update Date	:	02/09/2026

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Directions to “ ZACHARY L FERGUSON PA” Practice Location

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