Provider Demographics
NPI:1558310839
Name:FERGUSON, JAMES W (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:W
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:PO BOX 938
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76540-0938
Mailing Address - Country:US
Mailing Address - Phone:254-634-6999
Mailing Address - Fax:254-200-4090
Practice Address - Street 1:405 LONDONDERRY DR
Practice Address - Street 2:300
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7924
Practice Address - Country:US
Practice Address - Phone:254-772-2722
Practice Address - Fax:254-772-4075
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4327208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX20356263OtherBEECHSTREET
TX00FZ09OtherBLUE CROSS BLUE SHIELD
525245OtherUNITED HEALTHCARE
TX742330906001OtherHUMANA/MILITARY-TRICARE
TX112616100OtherFIRSTCARE
TX9486752001OtherCIGNA
TX091801301Medicaid
TX091801302OtherMEDICAID EPSDT
TX112616100OtherFIRSTCARE