Provider Demographics
NPI:1609840453
Name:FERGENSON, JON (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:FERGENSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 KNUTH RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-4629
Mailing Address - Country:US
Mailing Address - Phone:561-736-1200
Mailing Address - Fax:561-742-1919
Practice Address - Street 1:2815 S SEACREST BLVD
Practice Address - Street 2:ATTENTION: BETSY COX
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7934
Practice Address - Country:US
Practice Address - Phone:561-736-1200
Practice Address - Fax:561-742-1919
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME819982085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH23081Medicare UPIN