Provider Demographics
NPI:1053491811
Name:FERGUSON, SCOTT FRAZIER (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:FRAZIER
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1300 CENTERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4349
Mailing Address - Country:US
Mailing Address - Phone:870-741-2317
Mailing Address - Fax:870-741-4090
Practice Address - Street 1:715 W SHERMAN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601
Practice Address - Country:US
Practice Address - Phone:870-741-2317
Practice Address - Fax:870-741-4090
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE1390208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR143546001Medicaid
AR5L757Medicare PIN