Provider Demographics
NPI:1063470045
Name:FORD, DENNIS C (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:C
Last Name:FORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 KEITH ST NW
Mailing Address - Street 2:STE C
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-1351
Mailing Address - Country:US
Mailing Address - Phone:423-614-0535
Mailing Address - Fax:423-614-0545
Practice Address - Street 1:2020 KEITH ST NW
Practice Address - Street 2:STE C
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-1351
Practice Address - Country:US
Practice Address - Phone:423-614-0535
Practice Address - Fax:423-614-0545
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN12019207LP2900X
TN12143207Q00000X
TN1196208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3377550Medicaid
TN4439421OtherNCPDP
TN4041359OtherBLUE CROSS BLUE SHIELD
NC890641HMedicaid
TN12143OtherSTATE BOARD OF HEALTH
TNTN0101OtherJOHN DEERE
TNB04383Medicare UPIN
TN3189547Medicare PIN