Provider Demographics
NPI:1609197433
Name:FORDHAM, JANICE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:MARIE
Last Name:FORDHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:MARIE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1035 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MT
Mailing Address - Zip Code:59044-2119
Mailing Address - Country:US
Mailing Address - Phone:406-628-6311
Mailing Address - Fax:
Practice Address - Street 1:1035 1ST AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MT
Practice Address - Zip Code:59044-2119
Practice Address - Country:US
Practice Address - Phone:406-628-6311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT26048207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine