MEDICARE: JOHN B FERGUSON III 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	207W00000X	Ophthalmology Physician	DI-0000754	DE

Other Identifiers

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

General Provider Information

NPI Number	:	1790780534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN B FERGUSON III MD

Provider Business Mailing Address
First Line	:	2710 CENTERVILLE RD
Second Line	:	STE 102
City	:	WILMINGTON
State	:	DE
Zip	:	19808-1644
Country	:	US
Telephone Number	:	302-993-1300
Fax Number	:	302-993-1400

Provider Business Practice Location Address
First Line	:	2710 CENTERVILLE RD
Second Line	:	STE 102
City	:	WILMINGTON
State	:	DE
Zip	:	19808-1652
Country	:	US
Telephone Number	:	302-993-1300
Fax Number	:	302-993-1400

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	10/25/2012

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