Provider Demographics
NPI:1487676292
Name:FERGUSON, DOUGLAS BISMARK (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:BISMARK
Last Name:FERGUSON
Suffix:
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 1:202 CYPRESS CT
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-7555
Mailing Address - Country:US
Mailing Address - Phone:254-723-7784
Mailing Address - Fax:
Practice Address - Street 1:3500 I-30
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75185-1672
Practice Address - Country:US
Practice Address - Phone:972-698-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3353207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B87773Medicare UPIN