Provider Demographics
NPI:1265412738
Name:FERGUSON, JOHN P (DPM)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25500 N NORTERRA DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085
Mailing Address - Country:US
Mailing Address - Phone:623-277-1130
Mailing Address - Fax:866-837-6575
Practice Address - Street 1:3003 N 3RD STREET
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012
Practice Address - Country:US
Practice Address - Phone:602-282-9800
Practice Address - Fax:602-282-9694
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ531213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ733297Medicaid
AZ733297Medicaid
AZU95196Medicare UPIN