Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 38927 | CO |
NPI | 1083672430 |
---|---|
Provider Name | Dr. Tadd Rodney Ferguson |
First Address | Grand Junction, CO 81503-4514 |
Second Address | Denver, CO 80256-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 08/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04725531 | (05) | CO |
G99017 | (02) | CO |
T0304 | (05) | UT |