Provider Demographics
NPI:1760498703
Name:FERGUSON, GREGORY B (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:B
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 1:3340 NORTH CENTER ST #800
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7406
Mailing Address - Country:US
Mailing Address - Phone:801-990-1911
Mailing Address - Fax:801-990-1912
Practice Address - Street 1:3903 HARRISON BOULEVARD
Practice Address - Street 2:MCKAY DEE SURGICAL CENTER
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403
Practice Address - Country:US
Practice Address - Phone:801-507-5248
Practice Address - Fax:801-733-5618
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT82-168754-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID804108500Medicaid
AZ825242Medicaid
UT870545614FE1OtherEDUCATORS MUTUAL
UT53234OtherHEALTHY U
UTQM0000075886OtherALTIUS
NV100501894Medicaid
UT36399OtherDESERET MUTUAL
UT107005080101OtherIHC
UT2090168OtherUNITED HEALTHCARE
UT8597445OtherWORKERS COMP FUND
UTTPRA07661OtherMOLINA
UT1502954OtherUMWA
UT37782OtherPEHP
WY115511300Medicaid
UT2090168OtherUNITED HEALTHCARE
AZ825242Medicaid
WY115511300Medicaid