1679082523 NPI number — CHRISTOPHER WAYNE FERGUSON PA-C

Table of content: CHRISTOPHER WAYNE FERGUSON PA-C (NPI 1679082523)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679082523 NPI number — CHRISTOPHER WAYNE FERGUSON PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERGUSON
Provider First Name:
CHRISTOPHER
Provider Middle Name:
WAYNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679082523
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
77 E THOMAS RD STE 230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85012-3100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-557-0007
Provider Business Mailing Address Fax Number:
602-557-0001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1313 E. OSBORN RD.
Provider Second Line Business Practice Location Address:
STE 150
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-264-4431
Provider Business Practice Location Address Fax Number:
602-266-3870
Provider Enumeration Date:
09/22/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  6874 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com