Provider Demographics
NPI:1790785038
Name:FERGISON, RONALD (PA-C)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:FERGISON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 E ASH AVE
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-2205
Mailing Address - Country:US
Mailing Address - Phone:623-386-4011
Mailing Address - Fax:
Practice Address - Street 1:1315 E ASH AVE
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-2205
Practice Address - Country:US
Practice Address - Phone:623-386-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1072363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ158388Medicaid
AZ64261Medicare ID - Type UnspecifiedMARICOPA
AZ158388Medicaid