Provider Demographics
NPI:1366401176
Name:FERGUSON, MARY TROY (MD)
Entity type:Individual
Prefix:
First Name:MARY TROY
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:M. TROY
Other - Middle Name:
Other - Last Name:FERGUSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:748 S MEADOWS PKWY
Mailing Address - Street 2:A9-336
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-3861
Mailing Address - Country:US
Mailing Address - Phone:775-324-4040
Mailing Address - Fax:
Practice Address - Street 1:1155 MILL ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1576
Practice Address - Country:US
Practice Address - Phone:775-982-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9940207PE0004X, 207P00000X
WI65017-20207P00000X
NMMD2015-0932207P00000X
KS04-38648207P00000X
AZ51546207P00000X
MN60048207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCC3874OtherBC/BS
NV002016905Medicaid
NV201660026Medicaid
NVP00226663OtherRIALROAD MEDICARE
NVP00226663OtherRIALROAD MEDICARE
NVV100984Medicare ID - Type Unspecified