Provider Demographics
NPI:1659312205
Name:FERGUSON, HAROLD ALLEN JR (DO)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:ALLEN
Last Name:FERGUSON
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:450B WASHINGTON JACKSON RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320-7600
Mailing Address - Country:US
Mailing Address - Phone:937-456-8360
Mailing Address - Fax:937-456-8363
Practice Address - Street 1:450B WASHINGTON JACKSON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-7600
Practice Address - Country:US
Practice Address - Phone:937-456-8360
Practice Address - Fax:937-456-8363
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2017-04-20
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Provider Licenses
StateLicense IDTaxonomies
OH34004371207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00000177331OtherBLUE CROSS BLUE SHIELD OH
OH1971455OtherCIGNA
OH311212962026OtherCARESOURCE
OH34004371OtherMEDICAL LICENSE #
OH000000177331OtherNATIONAL BENEFIT FUND
OH31121296200OtherWORKERS COMP OHIO
OH110028240OtherRAILROAD MEDICARE-PALMETT
OH4358796OtherAETNA/US HEALTHCARE
OH0636177OtherAETNA/US HEALTHCARE HMO
OH000000177331OtherONE NATION BENEFIT ADMIN
OH0667292Medicaid
OH4358796OtherAETNA/US HEALTHCARE
OH31121296200OtherWORKERS COMP OHIO