MEDICARE: DR. CARL EDWARD FERGUSON D.O.

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	207Q00000X	Family Medicine Physician	2244	AZ

General Provider Information

NPI Number	:	1619068681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARL EDWARD FERGUSON D.O.

Provider Business Mailing Address
First Line	:	7529 E BASELINE
Second Line	:	SUITE 101
City	:	MESA
State	:	AZ
Zip	:	85208
Country	:	US
Telephone Number	:	480-945-4343
Fax Number	:	480-945-4350

Provider Business Practice Location Address
First Line	:	3514 N POWER RD STE 105
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85215-2907
Country	:	US
Telephone Number	:	480-422-8533
Fax Number	:	480-981-2442

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

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	03/17/2025

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