Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 11003063 | FL |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 11003063 | FL |
NPI | 1033771787 |
---|---|
Provider Name | Blair Andrew Ferguson |
First Address | Fort Lauderdale, FL 33304-2505 |
Second Address | Fort Lauderdale, FL 33304-2505 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2019 |
Last Update Date | 02/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11003063 | FLORIDA NURSING BOARD (01) | FL |