Provider Demographics
NPI:1003857236
Name:FORD, JANICE L (MD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:L
Last Name:FORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 MCMILLAN ROAD
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291
Mailing Address - Country:US
Mailing Address - Phone:318-396-3800
Mailing Address - Fax:318-329-8420
Practice Address - Street 1:1107 GLENWOOD DR
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-5503
Practice Address - Country:US
Practice Address - Phone:318-396-3800
Practice Address - Fax:318-329-8420
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8654207R00000X
LAMD.205149207R00000X, 207R00000X
LAMD205149208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G9389OtherBCBS
TX198386801Medicaid
TX8G9389OtherBCBS