Basic Information
| Provider Information | |||||||||
| NPI: | 1699783357 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | FERGUSON | ||||||||
| FirstName: | ERIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1895 KINGSLEY AVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | ORANGE PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320734466 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 1895 KINGSLEY AVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | ORANGE PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320734466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042762549 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 05/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0127X | ME131546 | FL | Y | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery |
No ID Information.