Provider Demographics
NPI:1356432702
Name:FERGUSON, MAX ANN (MD)
Entity type:Individual
Prefix:DR
First Name:MAX
Middle Name:ANN
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1140
Mailing Address - Street 2:715 W SHERMAN AVE SUITE A
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72602
Mailing Address - Country:US
Mailing Address - Phone:870-741-2317
Mailing Address - Fax:870-741-4090
Practice Address - Street 1:715 W SHERMAN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601
Practice Address - Country:US
Practice Address - Phone:870-741-2317
Practice Address - Fax:870-741-4090
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARC8467208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5K853Medicare PIN
G75028Medicare UPIN