Provider Demographics
NPI:1033265533
Name:FORD, LEAH HILARY (DPM)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:HILARY
Last Name:FORD
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18832 NW 12TH CT
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2953
Mailing Address - Country:US
Mailing Address - Phone:954-295-4091
Mailing Address - Fax:
Practice Address - Street 1:18832 NW 12TH CT
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2953
Practice Address - Country:US
Practice Address - Phone:954-295-4091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006179213ES0103X
FLP03315213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery