Provider Demographics
NPI:1588040588
Name:FERGUSON FAMILY PRACTICE & OCCUPATIONAL HEALTH, PLLC
Entity Type:Organization
Organization Name:FERGUSON FAMILY PRACTICE & OCCUPATIONAL HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-392-5556
Mailing Address - Street 1:1228 N HIGHWAY 123
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7730
Mailing Address - Country:US
Mailing Address - Phone:512-392-5556
Mailing Address - Fax:512-392-8828
Practice Address - Street 1:1228 N HIGHWAY 123
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7730
Practice Address - Country:US
Practice Address - Phone:512-392-5556
Practice Address - Fax:512-392-8828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-03
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP118410363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty