Provider Demographics
NPI:1932368834
Name:FERGUSON, LEE C (DO)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:C
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 DAUPHIN ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36604-2547
Mailing Address - Country:US
Mailing Address - Phone:251-445-0075
Mailing Address - Fax:251-445-0072
Practice Address - Street 1:1151 DAUPHIN ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-2547
Practice Address - Country:US
Practice Address - Phone:251-445-0075
Practice Address - Fax:251-445-0072
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS232262086S0129X
ALDO.12362086S0129X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL185176Medicaid
102I777294Medicare PIN