Basic Information
| Provider Information | |||||||||
| NPI: | 1871222000 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FERGUSON | ||||||||
| FirstName: | STUART | ||||||||
| MiddleName: | JOHN ROSS | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MBBS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8500, LOCKBOX 7642 | ||||||||
| Address2: | SHRINERS HOSPITALS FOR CHILDREN, PORTLAND | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191787642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8132818115 | ||||||||
| FaxNumber: | 8132818056 | ||||||||
| Practice Location | |||||||||
| Address1: | 3101 SW SAM JACKSON PARK RD | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972393009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032213424 | ||||||||
| FaxNumber: | 5032213490 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2022 | ||||||||
| LastUpdateDate: | 06/05/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.