Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A68471 | CA |
N | 111NI0900X | Internist | A68471 | CA |
Y | 207RA0401X | Internist - Addiction Medicine | A68471 | CA |
NPI | 1093756678 |
---|---|
Provider Name | Ms. Susan Callaway Ferguson |
First Address | Oakland Ca, CA 94612 |
Second Address | Oakland, CA 94612 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 04/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I16659 | (02) | CA |