Provider Demographics
NPI: | 1821190729 |
---|---|
Name: | FERGUSON, WILLIAM J JR (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | WILLIAM |
Middle Name: | J |
Last Name: | FERGUSON |
Suffix: | JR |
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: | PO BOX 2325 |
Mailing Address - Street 2: | |
Mailing Address - City: | ANNISTON |
Mailing Address - State: | AL |
Mailing Address - Zip Code: | 36202-2325 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 256-237-8811 |
Mailing Address - Fax: | 256-237-8823 |
Practice Address - Street 1: | 901 LEIGHTON AVE |
Practice Address - Street 2: | STE 305 |
Practice Address - City: | ANNISTON |
Practice Address - State: | AL |
Practice Address - Zip Code: | 36207 |
Practice Address - Country: | US |
Practice Address - Phone: | 256-237-8811 |
Practice Address - Fax: | 256-237-8823 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-09-01 |
Last Update Date: | 2014-02-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AL | 15223 | 207RC0200X, 207RP1001X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No | 207RC0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AL | 000086860 | Medicaid | |
D74186 | Medicare UPIN | ||
AL | 000086860 | Medicaid |