Provider Demographics
NPI:1902303100
Name:FERGUSON, MIRIAM DEBORA (MD)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:DEBORA
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MIRIAM
Other - Middle Name:DEBORA
Other - Last Name:VOLOSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6331 W MYSTIC MDW
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-2262
Mailing Address - Country:US
Mailing Address - Phone:206-962-7008
Mailing Address - Fax:
Practice Address - Street 1:6431 FANNIN ST STE 5.170
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1501
Practice Address - Country:US
Practice Address - Phone:713-500-7160
Practice Address - Fax:713-500-0648
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2023-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TNU3208390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program