Provider Demographics
NPI:1427105675
Name:FERGUSON, SUSAN M (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:M
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 1ST ST N
Mailing Address - Street 2:
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-8703
Mailing Address - Country:US
Mailing Address - Phone:205-664-4051
Mailing Address - Fax:205-664-4054
Practice Address - Street 1:1024 1ST ST N
Practice Address - Street 2:
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8703
Practice Address - Country:US
Practice Address - Phone:205-664-4051
Practice Address - Fax:205-664-4054
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4175207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051519329OtherBCBS PROVIDER ID
752974799OtherTAX ID
ALP00120269OtherRAILROAD MEDICARE/PGBA
AL108623Medicaid
AL009940155Medicaid
26-4105002OtherTAX ID
AL510-48638OtherBLUE CROSS BLUE SHIELD
AL510-48638OtherBLUE CROSS BLUE SHIELD
C73330Medicare UPIN