Provider Demographics
NPI:1336443704
Name:FERGUSON, LEE RONALD (MD/PHD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:RONALD
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:MD/PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11708 NW 27TH ST
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-3309
Mailing Address - Country:US
Mailing Address - Phone:352-284-4657
Mailing Address - Fax:
Practice Address - Street 1:11708 NW 27TH ST
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-3309
Practice Address - Country:US
Practice Address - Phone:352-284-4657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-28
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10132281-1205208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice