Provider Demographics
NPI:1942789086
Name:FERGUSON, RICHARD ADAM (PA-C)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ADAM
Last Name:FERGUSON
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 1:1260 5TH ST NE APT 106
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-2681
Mailing Address - Country:US
Mailing Address - Phone:214-735-4125
Mailing Address - Fax:
Practice Address - Street 1:2440 E 81ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-4200
Practice Address - Country:US
Practice Address - Phone:918-477-5190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant