Provider Demographics
NPI:1295842524
Name:FORD, ROBERT ORLAND (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ORLAND
Last Name:FORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1506
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-0409
Mailing Address - Country:US
Mailing Address - Phone:360-242-3008
Mailing Address - Fax:360-807-7687
Practice Address - Street 1:2517 NE KRESKY AVE
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-2409
Practice Address - Country:US
Practice Address - Phone:360-748-8632
Practice Address - Fax:360-748-3869
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00017790207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA180012493OtherRAIL ROAD MEDICARE
WA180040084OtherRAIL ROAD MEDICARE
ID1295842524Medicaid
AK1597601Medicaid
MT180044161OtherRAIL ROAD MEDICARE
NM25576356Medicaid
WA1005298Medicaid
AK180040079OtherRAIL ROAD MEDICARE
MT1295842524Medicaid
ID180010033OtherRAIL ROAD MEDICARE
WA180012488OtherRAIL ROAD MEDICARE
AKK150070Medicare PIN
E17470Medicare UPIN
WA180040084OtherRAIL ROAD MEDICARE
WAG000164901Medicare PIN
MT000082436Medicare PIN