Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 18375 | WI |
NPI | 1013972728 |
---|---|
Provider Name | Charles N Ford |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53792 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2006 |
Last Update Date | 05/02/2009 |