Provider Demographics
NPI:1194802991
Name:FERGUSON, DANIEL R (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:R
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3067
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95992-3067
Mailing Address - Country:US
Mailing Address - Phone:530-751-4784
Mailing Address - Fax:530-751-4906
Practice Address - Street 1:1007 LIVE OAK BLVD STE B2
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-3454
Practice Address - Country:US
Practice Address - Phone:530-671-8718
Practice Address - Fax:530-671-8725
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5039763-1205207V00000X
CAC151485207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002082780Medicaid
WY120029100Medicaid
UT1134379696Medicaid
P00697152Medicare PIN
UT005594501Medicare PIN
WY120029100Medicaid
UT000065083Medicare PIN