Jake Gage Ferguson

NPI #1336646058 in Pryor, Oklahoma

Provider Information

NPI Number: 1336646058
Entity Type: Individual
Name: Jake Gage Ferguson
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Peer Specialist
Enumeration Date: Apr 9, 2018
Last Updated: Apr 9, 2018

Practice Location

Address: 109 N FAIRLAND ST
City: Pryor
State: Oklahoma
ZIP Code: 74361-4203
Phone: (918) 825-1405

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Peer Specialist	175T00000X	Primary

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