Provider Demographics
NPI:1528166394
Name:FERGUSON, LEE PHILLIPS (MD)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:PHILLIPS
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 1:1100 OLIVE WAY
Mailing Address - Street 2:MS M4-PA
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1873
Mailing Address - Country:US
Mailing Address - Phone:206-583-6025
Mailing Address - Fax:206-515-5886
Practice Address - Street 1:1100 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2756
Practice Address - Country:US
Practice Address - Phone:206-223-6600
Practice Address - Fax:206-515-5886
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041579207R00000X
WAMD00047328207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0039581OtherLABOR AND INDUSTRIES #
WA8482812Medicaid
WAUS7947447OtherAETNA PCP PIN
WA8889833OtherMC PTAN - KITSAP CO
WA5536FEOtherBLUE SHIELD #
WAUS7947447OtherAETNA PCP PIN
I68205Medicare UPIN