Basic Information
| Provider Information | |||||||||
| NPI: | 1609840453 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FERGENSON | ||||||||
| FirstName: | JON | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 KNUTH RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BOYNTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334364629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617361200 | ||||||||
| FaxNumber: | 5617421919 | ||||||||
| Practice Location | |||||||||
| Address1: | 2815 S SEACREST BLVD | ||||||||
| Address2: | ATTENTION: BETSY COX | ||||||||
| City: | BOYNTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334357934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617361200 | ||||||||
| FaxNumber: | 5617421919 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085N0700X | ME81998 | FL | Y | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology |
No ID Information.