Provider Demographics
NPI:1235164708
Name:R J FORD MD PA
Entity Type:Organization
Organization Name:R J FORD MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-599-4464
Mailing Address - Street 1:PO BOX 1207
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-1207
Mailing Address - Country:US
Mailing Address - Phone:817-599-4464
Mailing Address - Fax:817-599-5316
Practice Address - Street 1:925 HILLTOP DR
Practice Address - Street 2:STE 101
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5889
Practice Address - Country:US
Practice Address - Phone:817-599-4464
Practice Address - Fax:817-599-5316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9432207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098721601Medicaid
TX098721604Medicaid
TXDG6383OtherMEDICARE RAILROAD
TX0083QSOtherBCBS
TX098721601Medicaid
TX00595ZMedicare ID - Type UnspecifiedTARRANT CO
TX098721604Medicaid