Provider Demographics
NPI:1487839940
Name:GERALD P. FORD, M.D. P.C
Entity Type:Organization
Organization Name:GERALD P. FORD, M.D. P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:PENNY
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-967-3381
Mailing Address - Street 1:2600 S RURAL RD STE B
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-2448
Mailing Address - Country:US
Mailing Address - Phone:480-967-3381
Mailing Address - Fax:480-967-0755
Practice Address - Street 1:2600 S RURAL RD STE B
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-2448
Practice Address - Country:US
Practice Address - Phone:480-967-3381
Practice Address - Fax:480-967-0755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7813207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4022003OtherAETNA
AZ180005504OtherRAILROAD MEDICARE
AZ246703Medicaid
AZAZ0017680OtherBLUECROSS BLUE SHIELD
AZZWDCFHMedicare PIN