Provider Demographics
NPI:1225077084
Name:FORD, CLYDE DONALD JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CLYDE
Middle Name:DONALD
Last Name:FORD
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DON
Other - Middle Name:
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4660 SWEETWATER BLVD
Mailing Address - Street 2:SUITE NO. 190
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3011
Mailing Address - Country:US
Mailing Address - Phone:281-494-4004
Mailing Address - Fax:281-494-8899
Practice Address - Street 1:4660 SWEETWATER BLVD
Practice Address - Street 2:SUITE NO. 190
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3011
Practice Address - Country:US
Practice Address - Phone:281-494-4004
Practice Address - Fax:281-494-8899
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0904207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine