Basic Information
| Provider Information | |||||||||
| NPI: | 1760498703 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FERGUSON | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3340 NORTH CENTER ST #800 | ||||||||
| Address2: | |||||||||
| City: | LEHI | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840437406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019901911 | ||||||||
| FaxNumber: | 8019901912 | ||||||||
| Practice Location | |||||||||
| Address1: | 3903 HARRISON BOULEVARD | ||||||||
| Address2: | MCKAY DEE SURGICAL CENTER | ||||||||
| City: | OGDEN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015075248 | ||||||||
| FaxNumber: | 8017335618 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 10/15/2012 | ||||||||
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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 | 207L00000X | 82-168754-1205 | UT | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 804108500 | 05 | ID | MEDICAID | 825242 | 05 | AZ | MEDICAID | 870545614FE1 | 01 | UT | EDUCATORS MUTUAL | OTHER | 53234 | 01 | UT | HEALTHY U | OTHER | QM0000075886 | 01 | UT | ALTIUS | OTHER | 100501894 | 05 | NV | MEDICAID | 36399 | 01 | UT | DESERET MUTUAL | OTHER | 107005080101 | 01 | UT | IHC | OTHER | 2090168 | 01 | UT | UNITED HEALTHCARE | OTHER | 8597445 | 01 | UT | WORKERS COMP FUND | OTHER | TPRA07661 | 01 | UT | MOLINA | OTHER | 1502954 | 01 | UT | UMWA | OTHER | 37782 | 01 | UT | PEHP | OTHER | 115511300 | 05 | WY | MEDICAID |