Provider Demographics
NPI:1023667870
Name:FERGUSON, HOWARD DWAYNE
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:DWAYNE
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 C R SMITH ST APT 14
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-2977
Mailing Address - Country:US
Mailing Address - Phone:404-442-3160
Mailing Address - Fax:
Practice Address - Street 1:3001 C R SMITH ST APT 14
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-2977
Practice Address - Country:US
Practice Address - Phone:404-442-3160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-04
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)