Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD27372 | OR |
N | 111NI0900X | Internist | MD27372 | OR |
N | 207RA0401X | Internist - Addiction Medicine | MD27372 | OR |
NPI | 1447375233 |
---|---|
Provider Name | Dr. Casey Elizabeth Ferguson |
First Address | Portland, OR 97214-1328 |
Second Address | Portland, OR 97213-2933 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 08/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
243094 | (05) | OR |
92075355 | (05) | NM |
I01676 | (02) | |
P00464817 | RAILROAD MEDICARE - PROVIDENCE (01) | OR |