Rae Jean De Leon Ferguson

Primary specialty

ContractorTaxonomy code 171W00000X

License

11264 Issued in AZ

Practice address

24743 W Illini St
Buckeye, AZ 85326-3376

Phone

(623) 386-7631

NPI assigned

Jan 25, 2007

Last updated

Oct 13, 2009By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mrs. Rae Jean Deleon Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1255392000000",
    "number": "1154477123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24743 W ILLINI ST",
            "city": "BUCKEYE",
            "state": "AZ",
            "postal_code": "853263376",
            "telephone_number": "623-386-7631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24743 W ILLINI ST",
            "city": "BUCKEYE",
            "state": "AZ",
            "postal_code": "853263376",
            "telephone_number": "623-386-7631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE LEON FERGUSON",
        "first_name": "RAE",
        "middle_name": "JEAN",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-25",
        "last_updated": "2009-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171W00000X",
            "taxonomy_group": "",
            "desc": "Contractor",
            "state": "AZ",
            "license": "11264",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "171W00000X",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RAE",
            "last_name": "DELEON",
            "middle_name": "JEAN",
            "prefix": "MRS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Dental Foundations and Aesthetics
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• Dentists at Buckeye Commons, LLP

• Contractor in Buckeye, AZ
• Providers in Buckeye, AZ by specialty
• Contractor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.