Provider Demographics
NPI:1487728465
Name:FERGUSON, JOHN CHRISTIAN (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHRISTIAN
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1118 ROSS CLARK CIR
Mailing Address - Street 2:STE. 210
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-3001
Mailing Address - Country:US
Mailing Address - Phone:334-702-6900
Mailing Address - Fax:334-677-7749
Practice Address - Street 1:1118 ROSS CLARK CIR
Practice Address - Street 2:STE. 210
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3001
Practice Address - Country:US
Practice Address - Phone:334-702-6900
Practice Address - Fax:334-677-7749
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL00025142207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALH82665Medicare UPIN