Provider Demographics
NPI:1548215882
Name:FERGUSON, RICHARD BURKS (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:BURKS
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 1:8 S RUE CHARLES
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5157
Mailing Address - Country:US
Mailing Address - Phone:210-822-4647
Mailing Address - Fax:
Practice Address - Street 1:8 S RUE CHARLES
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5157
Practice Address - Country:US
Practice Address - Phone:210-822-4647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4328207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX654321Medicare UPIN