Provider Demographics
NPI:1558350421
Name:FERGUSON, JOSEPH MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MARTIN
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 5409
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79608-5409
Mailing Address - Country:US
Mailing Address - Phone:325-670-6456
Mailing Address - Fax:325-670-6430
Practice Address - Street 1:1150 N 18TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2948
Practice Address - Country:US
Practice Address - Phone:325-670-6456
Practice Address - Fax:325-670-6430
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3917207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB87767Medicare UPIN
TX838056Medicare ID - Type Unspecified
TX838056Medicare PIN