Provider Demographics
NPI:1366699217
Name:FERGUSON, ROGER JOHN (MD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:JOHN
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8029 LONGBAY BLVD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-2043
Mailing Address - Country:US
Mailing Address - Phone:941-355-8949
Mailing Address - Fax:041-355-8949
Practice Address - Street 1:8029 LONGBAY BLVD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2043
Practice Address - Country:US
Practice Address - Phone:941-355-8949
Practice Address - Fax:941-355-8949
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD013996E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery