Provider Demographics
NPI:1629178603
Name:FERGUSON, THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:FERGUSON
Suffix:
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 1:3809 COVINGTON PIKE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38135-2209
Mailing Address - Country:US
Mailing Address - Phone:901-386-1625
Mailing Address - Fax:901-377-8986
Practice Address - Street 1:3809 COVINGTON PIKE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38135-2209
Practice Address - Country:US
Practice Address - Phone:901-386-1625
Practice Address - Fax:901-377-8986
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000029834174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4002378OtherBLUE CROSS
TN110219636OtherRAILROAD MEDICARE
TN3821473Medicaid
TN3821475Medicare ID - Type Unspecified
TN3821473Medicaid