Provider Demographics
NPI:1447433420
Name:KAREN L FERGUSON MD PA
Entity type:Organization
Organization Name:KAREN L FERGUSON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-299-0721
Mailing Address - Street 1:3755 7TH TERRACE
Mailing Address - Street 2:SUITE 302A
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6557
Mailing Address - Country:US
Mailing Address - Phone:772-299-0721
Mailing Address - Fax:772-299-0723
Practice Address - Street 1:3755 7TH TER
Practice Address - Street 2:SUITE 302A
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6528
Practice Address - Country:US
Practice Address - Phone:772-299-0721
Practice Address - Fax:772-299-0723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME37491207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD54625Medicare UPIN
FLK4025Medicare PIN