Provider Demographics
NPI:1326389271
Name:FERGUSON, JEFFREY DAVENPORT (ATC)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:DAVENPORT
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4949 CENTENNIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054-1229
Mailing Address - Country:US
Mailing Address - Phone:408-562-4947
Mailing Address - Fax:408-727-1312
Practice Address - Street 1:4949 CENTENNIAL BLVD
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-1229
Practice Address - Country:US
Practice Address - Phone:408-562-4947
Practice Address - Fax:408-727-1312
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer