Provider Demographics
NPI:1174657480
Name:FORD, ROBERT ANTHONY (MED)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ANTHONY
Last Name:FORD
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 OXFORD ST.
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46806
Mailing Address - Country:US
Mailing Address - Phone:260-744-1144
Mailing Address - Fax:260-745-0978
Practice Address - Street 1:525 OXFORD ST.
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46806
Practice Address - Country:US
Practice Address - Phone:260-744-1144
Practice Address - Fax:260-745-0978
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator