Provider Demographics
NPI:1639269665
Name:FERGUSON, PATRIC WESLEY (MD)
Entity Type:Individual
Prefix:
First Name:PATRIC
Middle Name:WESLEY
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 1:175 TRYON RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:RUTHERFORDTON
Mailing Address - State:NC
Mailing Address - Zip Code:28139-3036
Mailing Address - Country:US
Mailing Address - Phone:828-286-0632
Mailing Address - Fax:828-286-5644
Practice Address - Street 1:175 TRYON RD
Practice Address - Street 2:SUITE A
Practice Address - City:RUTHERFORDTON
Practice Address - State:NC
Practice Address - Zip Code:28139-3036
Practice Address - Country:US
Practice Address - Phone:828-286-0632
Practice Address - Fax:828-286-5644
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35330207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890221RMedicaid
D80555Medicare UPIN
NC890221RMedicaid