Provider Demographics
NPI:1235278128
Name:FERGUSON, WALTER L JR (MD)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:L
Last Name:FERGUSON
Suffix:JR
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 1:40 KINGS DR
Mailing Address - Street 2:
Mailing Address - City:TUXEDO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:10987-5505
Mailing Address - Country:US
Mailing Address - Phone:718-560-6912
Mailing Address - Fax:845-744-9107
Practice Address - Street 1:40 KINGS DR
Practice Address - Street 2:
Practice Address - City:TUXEDO PARK
Practice Address - State:NY
Practice Address - Zip Code:10987-5505
Practice Address - Country:US
Practice Address - Phone:718-560-6912
Practice Address - Fax:845-744-9107
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164524-1207R00000X
NJ25MA08876800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine