Provider Demographics
NPI:1477996072
Name:FORD, LA DONNA D (MD)
Entity Type:Individual
Prefix:
First Name:LA DONNA
Middle Name:D
Last Name:FORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 BARBADOS LN
Mailing Address - Street 2:
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-3972
Mailing Address - Country:US
Mailing Address - Phone:650-341-1918
Mailing Address - Fax:
Practice Address - Street 1:512 BARBADOS LN
Practice Address - Street 2:
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404-3972
Practice Address - Country:US
Practice Address - Phone:650-341-1918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC7270207L00000X
CAA052943207L00000X
TXK9270207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A529430Medicaid
CA00A529430Medicare UPIN