MEDICARE: ASHLEY FERGUSON

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	335E00000X	Prosthetic/Orthotic Supplier	1527143	TX

General Provider Information

NPI Number	:	1841780962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY FERGUSON

Provider Business Mailing Address
First Line	:	1811 GREENVILLE AVE STE 100
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-7485
Country	:	US
Telephone Number	:	469-970-2758
Fax Number	:

Provider Business Practice Location Address
First Line	:	1811 GREENVILLE AVE STE 100
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-7485
Country	:	US
Telephone Number	:	469-970-2758
Fax Number	:

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

Provider Enumeration Date	:	05/14/2018
Last Update Date	:	05/14/2018

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Directions to “ ASHLEY FERGUSON ” Practice Location

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