Provider Demographics
NPI:1174722896
Name:FERGUSON, LOUIS FRED (BC-HIS)
Entity type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:FRED
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-2548
Mailing Address - Country:US
Mailing Address - Phone:925-778-6665
Mailing Address - Fax:925-778-9235
Practice Address - Street 1:15 W 18TH ST
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-2548
Practice Address - Country:US
Practice Address - Phone:925-778-6665
Practice Address - Fax:925-778-9235
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA 2799237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist