Provider Demographics
NPI:1548254865
Name:FERGUSON, APRIL M (DO)
Entity type:Individual
Prefix:DR
First Name:APRIL
Middle Name:M
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 STADIUM RD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-2400
Mailing Address - Country:US
Mailing Address - Phone:386-254-1149
Mailing Address - Fax:386-236-3300
Practice Address - Street 1:420 STADIUM RD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2400
Practice Address - Country:US
Practice Address - Phone:386-254-1149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 9094207Q00000X
FLOS9094207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269606100Medicaid
FLI 18476Medicare UPIN
FL50290YMedicare PIN