Provider Demographics
NPI:1518928654
Name:FORD, RICKY JOE (MD)
Entity Type:Individual
Prefix:
First Name:RICKY
Middle Name:JOE
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 1207
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-1207
Mailing Address - Country:US
Mailing Address - Phone:817-599-4464
Mailing Address - Fax:817-599-5316
Practice Address - Street 1:925 HILLTOP DR
Practice Address - Street 2:STE 101
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5889
Practice Address - Country:US
Practice Address - Phone:817-599-4464
Practice Address - Fax:817-599-5316
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9432207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AJ899OtherBCBS
TX098721604Medicaid
010017146OtherRAILROAD MEDICARE
TX010017147OtherRAILROAD MEDICARE
TX0987216-01Medicaid
010017146OtherRAILROAD MEDICARE
TX8F1289Medicare PIN
TX8F1290Medicare PIN