Provider Demographics
NPI:1568601516
Name:FORD, DANIELLE R (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:R
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 1:3824 CEDAR SPRINGS RD # 238
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4136
Mailing Address - Country:US
Mailing Address - Phone:214-810-8808
Mailing Address - Fax:
Practice Address - Street 1:2400 N INTERSTATE HIGHWAY 35 E
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-5240
Practice Address - Country:US
Practice Address - Phone:469-843-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-16
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100879207R00000X
TXN3645207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX208260402Medicaid
TX2082604-03Medicaid
TX2082604-03Medicaid
TX208260402Medicaid
TXTXB132524Medicare PIN
TX8L15416Medicare PIN