Provider Demographics
NPI:1619124989
Name:FERGUSON, TIFFANY R (DO)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:R
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:TIFFANY
Other - Middle Name:R
Other - Last Name:PINKERTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1600 W UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-3045
Mailing Address - Country:US
Mailing Address - Phone:580-924-5500
Mailing Address - Fax:580-924-1991
Practice Address - Street 1:1600 W UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-3045
Practice Address - Country:US
Practice Address - Phone:580-924-5500
Practice Address - Fax:580-924-1991
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4677207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK37105OtherOBNDD
OK402616OtherPTAN
OK4677OtherSTATE LICENSURE
OK4677OtherSTATE LICENSURE