Provider Demographics
NPI:1770977035
Name:FERGUSON, BRIAN (DO;MPH)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:DO;MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:KEESLER MEDICAL CENTER
Mailing Address - Street 2:500 FISHER ST
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39534
Mailing Address - Country:US
Mailing Address - Phone:228-376-2273
Mailing Address - Fax:
Practice Address - Street 1:KEESLER MEDICAL CENTER
Practice Address - Street 2:500 FISHER ST
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39534
Practice Address - Country:US
Practice Address - Phone:228-376-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-25
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS26374207P00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty