Provider Demographics
NPI:1790780534
Name:FERGUSON, JOHN B III (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:FERGUSON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2710 CENTERVILLE RD
Mailing Address - Street 2:STE 102
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-1644
Mailing Address - Country:US
Mailing Address - Phone:302-993-1300
Mailing Address - Fax:302-993-1400
Practice Address - Street 1:2710 CENTERVILLE RD
Practice Address - Street 2:STE 102
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-1652
Practice Address - Country:US
Practice Address - Phone:302-993-1300
Practice Address - Fax:302-993-1400
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEDI-0000754207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000157601Medicaid
DE0000157601Medicaid
DE007017D54Medicare ID - Type Unspecified