Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | DS037873 | PA |
N | 204E00000X | Oral & Maxillofacial Surgeon | DS037873 | PA |
Y | 204E00000X | Oral & Maxillofacial Surgeon | MD456122 | PA |
NPI | 1578799862 |
---|---|
Provider Name | Dr. Brian P. Ford |
First Address | Philadelphia, PA 19104-5127 |
Second Address | Philadelphia, PA 19104-5127 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2009 |
Last Update Date | 26/09/2019 |