Provider Demographics
NPI:1750072120
Name:FERGUSON, BRANDON MATTHEW
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:MATTHEW
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 ROYAL BIRKDALE
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-9597
Mailing Address - Country:US
Mailing Address - Phone:614-477-0839
Mailing Address - Fax:614-477-0839
Practice Address - Street 1:80 ROYAL BIRKDALE
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-9597
Practice Address - Country:US
Practice Address - Phone:614-477-0839
Practice Address - Fax:614-477-0839
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty