Provider Demographics
NPI:1033112768
Name:FERGUSON, WILLIAM W (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:W
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 1:1041 N CHINA LAKE BLVD
Mailing Address - Street 2:B
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-3183
Mailing Address - Country:US
Mailing Address - Phone:760-446-6404
Mailing Address - Fax:760-446-6415
Practice Address - Street 1:1041 N CHINA LAKE BLVD
Practice Address - Street 2:B
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-3183
Practice Address - Country:US
Practice Address - Phone:760-446-6404
Practice Address - Fax:760-446-6415
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42555207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA770445816OtherFEDERAL TAX ID NUMBER
CAD20275Medicare UPIN
CA770445816OtherFEDERAL TAX ID NUMBER
CAZZZ14433ZMedicare PIN
CAAT987ZMedicare PIN