Provider Demographics
NPI:1609033802
Name:FORD, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:FORD
Suffix:
Gender:M
Credentials:
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 3923
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71133-3923
Mailing Address - Country:US
Mailing Address - Phone:800-684-0052
Mailing Address - Fax:405-844-1794
Practice Address - Street 1:240 HIGHLAND DR
Practice Address - Street 2:EMERGENCY DEPT
Practice Address - City:MANY
Practice Address - State:LA
Practice Address - Zip Code:71449-3718
Practice Address - Country:US
Practice Address - Phone:405-844-1830
Practice Address - Fax:405-341-9217
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA204379207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA05510Medicaid
LA1055107Medicaid
LA1055107Medicaid