Provider Demographics
NPI:1871554725
Name:FERGUS, KATHRYN ROSE (MD)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:ROSE
Last Name:FERGUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:ANN
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1319 PUNAHOU ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1001
Mailing Address - Country:US
Mailing Address - Phone:808-983-6108
Mailing Address - Fax:
Practice Address - Street 1:1319 PUNAHOU ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1001
Practice Address - Country:US
Practice Address - Phone:808-983-6108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100971208000000X
HI17279208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL31529OtherBC/BS
7949594OtherAETNA
1299176OtherCIGNA
FL280708400Medicaid
460084OtherSTAYWELL/HEALTHEASE
316281OtherAVMED
460084OtherSTAYWELL/HEALTHEASE
460084OtherSTAYWELL/HEALTHEASE
7949594OtherAETNA