Provider Demographics
NPI:1013965623
Name:FERGUSON, STEVE G (MD)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:G
Last Name:FERGUSON
Suffix:
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 1:1817 CUMBERLAND AVE
Mailing Address - Street 2:#370
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-3009
Mailing Address - Country:US
Mailing Address - Phone:865-541-1167
Mailing Address - Fax:865-541-3977
Practice Address - Street 1:1901 W CLINCH AVE
Practice Address - Street 2:SUITE 301 EAST
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-2307
Practice Address - Country:US
Practice Address - Phone:865-541-1167
Practice Address - Fax:865-541-3977
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD18844208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3038496Medicaid
TN3038496Medicaid
C36427Medicare UPIN