Provider Demographics
NPI:1346935657
Name:FERGUSON, MORGAN LANE (DO)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:LANE
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 N LOCUST GROVE RD UNIT 27D
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-7674
Mailing Address - Country:US
Mailing Address - Phone:530-410-9859
Mailing Address - Fax:
Practice Address - Street 1:860 S MADISON ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4905
Practice Address - Country:US
Practice Address - Phone:662-377-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program