Provider Demographics
NPI:1528176989
Name:FERGUSON, MONICA O (MD)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:O
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 DOYLE PARK DR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4558
Mailing Address - Country:US
Mailing Address - Phone:707-303-8300
Mailing Address - Fax:707-303-8301
Practice Address - Street 1:500 DOYLE PARK DR
Practice Address - Street 2:SUITE 303
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4558
Practice Address - Country:US
Practice Address - Phone:707-303-8300
Practice Address - Fax:707-303-8301
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD066523L207R00000X
CAC137803207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001708137Medicaid
PAG81421Medicare UPIN
PA020593F15Medicare PIN