MEDICARE: DENNIS BURKE FERGUSON PH.D.

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	103T00000X	Psychologist	797	OK

General Provider Information

NPI Number	:	1912971417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENNIS BURKE FERGUSON PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 16337
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73113-2337
Country	:	US
Telephone Number	:	405-858-7773
Fax Number	:	405-858-7774

Provider Business Practice Location Address
First Line	:	1608 NW EXPRESSWAY ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-1402
Country	:	US
Telephone Number	:	405-858-7773
Fax Number	:	405-858-7774

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

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	07/08/2007

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