Provider Demographics
NPI:1326017864
Name:FORD JR, WILLIAM R (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:FORD JR
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 1:2345 E PRATER WAY
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-9600
Mailing Address - Country:US
Mailing Address - Phone:775-359-5757
Mailing Address - Fax:775-359-3763
Practice Address - Street 1:2345 E PRATER WAY
Practice Address - Street 2:SUITE 303
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-9600
Practice Address - Country:US
Practice Address - Phone:775-359-5757
Practice Address - Fax:775-359-3763
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV0660140001Medicare NSC
C96037Medicare UPIN