Provider Demographics
NPI:1679576292
Name:FERGUSON, KATHERINE STIRK (MD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:STIRK
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 N CHINA LAKE BLVD
Mailing Address - Street 2:B
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-3168
Mailing Address - Country:US
Mailing Address - Phone:760-446-6404
Mailing Address - Fax:760-446-6415
Practice Address - Street 1:1041 N CHINA LAKE BLVD
Practice Address - Street 2:B
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-3168
Practice Address - Country:US
Practice Address - Phone:760-446-6404
Practice Address - Fax:760-446-6415
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC425540208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA770445816OtherFEDERAL TAX ID NUMBER
CAZZZ14433ZMedicare PIN
CAD20450Medicare UPIN
CA00C425540Medicare PIN
CAAZ734ZMedicare PIN