Provider Demographics
NPI:1689639775
Name:FERGUSON, ELAINE L (DO)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:L
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2090 S OHIO ST
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-6702
Mailing Address - Country:US
Mailing Address - Phone:785-825-8221
Mailing Address - Fax:785-825-0644
Practice Address - Street 1:2090 S OHIO ST
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-6702
Practice Address - Country:US
Practice Address - Phone:785-825-8221
Practice Address - Fax:785-825-0644
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2018-12-14
Deactivation Date:2018-12-11
Deactivation Code:
Reactivation Date:2018-12-14
Provider Licenses
StateLicense IDTaxonomies
KS0520829207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100203040DMedicaid
KSD77655Medicare UPIN
KS110116047Medicare PIN