Provider Demographics
NPI:1376544411
Name:FERGUSON, DOUGLAS (CRNA)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 CENTRAL AVE
Mailing Address - Street 2:SUITE 323
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-6420
Mailing Address - Country:US
Mailing Address - Phone:603-749-0043
Mailing Address - Fax:603-749-0135
Practice Address - Street 1:333 BORTHWICK AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-7128
Practice Address - Country:US
Practice Address - Phone:603-436-5110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0324952311367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH40000024Medicaid
NH40000024Medicaid