MEDICARE: JEFFREY H FERGUSON 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	207Q00000X	Family Medicine Physician	01024850A	IN

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	:	1871567057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY H FERGUSON MD

Provider Business Mailing Address
First Line	:	8840 COMMERCE PARK PL STE E
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-3129
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10603 N MERIDIAN ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46290-1055
Country	:	US
Telephone Number	:	317-415-6050
Fax Number	:

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	11/05/2014

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