Provider Demographics
NPI:1376523951
Name:FORD, RYAN DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:DEAN
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 847522
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7522
Mailing Address - Country:US
Mailing Address - Phone:903-531-5000
Mailing Address - Fax:
Practice Address - Street 1:2026 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-5822
Practice Address - Country:US
Practice Address - Phone:903-541-4599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5335207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75-0818167-022OtherTRICARE
TX155141816Medicaid
TX8A5545OtherBCBS
TX155141819Medicaid
TX75-2616977-042OtherTRICARE
TX155141817Medicaid
TX155141818Medicaid
TX8DC706OtherBCBS
TX155141813Medicaid
TX75-1976930-005OtherTRICARE
TX8F2441Medicare ID - Type Unspecified
TX155141816Medicaid
TX155141817Medicaid
TX75-2616977-042OtherTRICARE
TX155141819Medicaid
TX155141818Medicaid
TXTXB147551Medicare PIN