Provider Demographics
NPI:1912996794
Name:FERGUSON, KENNETH H (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:H
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:855-771-0335
Mailing Address - Fax:
Practice Address - Street 1:2030 SUTTER PL
Practice Address - Street 2:SUITE 1000
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-6212
Practice Address - Country:US
Practice Address - Phone:530-750-5995
Practice Address - Fax:530-750-5905
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2020-03-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA90492208800000X
VA0101058329208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAQ140ZMedicare PIN