Provider Demographics
NPI:1629031604
Name:FERGUSON, EDGAR SCOTT SR (MD)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:SCOTT
Last Name:FERGUSON
Suffix:SR
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 1:200 SOUTH RHODES
Mailing Address - Street 2:SUITE B
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301
Mailing Address - Country:US
Mailing Address - Phone:870-735-5555
Mailing Address - Fax:870-735-5660
Practice Address - Street 1:200 SOUTH RHODES
Practice Address - Street 2:SUITE B
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301
Practice Address - Country:US
Practice Address - Phone:870-735-5555
Practice Address - Fax:870-735-5660
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC63042085R0202X
TNMD146622085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR51645Medicare ID - Type Unspecified
D79412Medicare UPIN