Provider Demographics
NPI:1902018294
Name:FERGUSON, JON EDWARD (DO)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:EDWARD
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 CERES AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-5635
Mailing Address - Country:US
Mailing Address - Phone:530-899-7090
Mailing Address - Fax:
Practice Address - Street 1:3011 CERES AVE STE 100
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-5637
Practice Address - Country:US
Practice Address - Phone:602-317-5928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR757207R00000X
CA20A11757207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1902018294Medicaid
CA1902018294Medicaid