Provider Demographics
NPI:1114088267
Name:ALEXANDR P. FORD, M.D.
Entity Type:Organization
Organization Name:ALEXANDR P. FORD, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-277-6405
Mailing Address - Street 1:1125 S BEVERLY DR STE 700
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1148
Mailing Address - Country:US
Mailing Address - Phone:310-277-6405
Mailing Address - Fax:310-277-2852
Practice Address - Street 1:1125 S BEVERLY DR STE 700
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1148
Practice Address - Country:US
Practice Address - Phone:310-277-6405
Practice Address - Fax:310-277-2852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG57387261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA60208Medicare UPIN