Provider Demographics
NPI:1932392289
Name:FERGUSON, MORRIS DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MORRIS
Middle Name:DEAN
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-3721
Mailing Address - Country:US
Mailing Address - Phone:615-453-7450
Mailing Address - Fax:615-453-7451
Practice Address - Street 1:500 PARK AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3721
Practice Address - Country:US
Practice Address - Phone:615-453-7450
Practice Address - Fax:615-453-7451
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3143208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
B01392Medicare UPIN