Provider Demographics
NPI:1164495206
Name:FORD, JUDITH P (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:P
Last Name:FORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 98978
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-8978
Mailing Address - Country:US
Mailing Address - Phone:702-507-2466
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:9280 W SUNSET RD
Practice Address - Street 2:SUITE 426
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4860
Practice Address - Country:US
Practice Address - Phone:702-262-0124
Practice Address - Fax:702-262-0143
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV10447207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1164495206Medicaid
NV1164495206Medicaid
NVAO637WMedicare PIN