Provider Demographics
NPI:1710998422
Name:FERGUSON, THOMAS JEFFREY (MD, PHD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JEFFREY
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3044 DONATO LN
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-6553
Mailing Address - Country:US
Mailing Address - Phone:530-753-6499
Mailing Address - Fax:
Practice Address - Street 1:1 SHIELDS AVE
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-5270
Practice Address - Country:US
Practice Address - Phone:530-752-2300
Practice Address - Fax:530-752-2306
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG63228207PT0002X, 207R00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207PT0002XAllopathic & Osteopathic PhysiciansEmergency MedicineMedical Toxicology
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE56224Medicare UPIN
CA00G632280Medicare ID - Type Unspecified