Provider Demographics
NPI:1336195098
Name:FERGUSON, GEORGE W (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:W
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 1:1333 3RD AVE S STE 402
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-6535
Mailing Address - Country:US
Mailing Address - Phone:239-352-5600
Mailing Address - Fax:239-353-8900
Practice Address - Street 1:1333 3RD AVE S STE 402
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-6535
Practice Address - Country:US
Practice Address - Phone:239-352-5600
Practice Address - Fax:239-353-8900
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0048992207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40916AOtherBLUE CROSS
FL043075700Medicaid
FL4533225OtherAETNA
FL0404814OtherUNITED HEALTH CARE
FL276770OtherONE HEALTH PLAN
FLD61164Medicare UPIN
FL0404814OtherUNITED HEALTH CARE