Provider Demographics
NPI:1619086576
Name:RONNEY L. FERGUSON, M.D., P.C.
Entity Type:Organization
Organization Name:RONNEY L. FERGUSON, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONNEY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-537-7557
Mailing Address - Street 1:2051 E EVERGREEN LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901
Mailing Address - Country:US
Mailing Address - Phone:928-537-7557
Mailing Address - Fax:928-537-7594
Practice Address - Street 1:2051 E EVERGREEN LN
Practice Address - Street 2:SUITE A
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901
Practice Address - Country:US
Practice Address - Phone:928-537-7557
Practice Address - Fax:928-537-7594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28951207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5876470001Medicare NSC