Provider Demographics
NPI:1265403810
Name:FERGUSON, LANCE STIRLING (MD)
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:STIRLING
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2353 ALEXANDRIA DR
Mailing Address - Street 2:SUITE 350
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3264
Mailing Address - Country:US
Mailing Address - Phone:859-224-2655
Mailing Address - Fax:859-223-7147
Practice Address - Street 1:2353 ALEXANDRIA DR
Practice Address - Street 2:SUITE 260
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3264
Practice Address - Country:US
Practice Address - Phone:859-224-2655
Practice Address - Fax:859-223-7147
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY24147207W00000X
OH35046757207W00000X
MTMED-PHYS-LIC-27425207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64241474Medicaid
KY64241474Medicaid
KY0094501Medicare PIN