Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | L6382 | TX |
NPI | 1023080900 |
---|---|
Provider Name | William R. Ford |
First Address | Fairfax, OK 74637-3023 |
Second Address | Ponca City, OK 74601-4335 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2006 |
Last Update Date | 18/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200074150A | (05) | OK |
BF317870 | DEA (01) |