Provider Demographics
NPI:1609330646
Name:FORD, CHERYL (NP-C)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7381 E CAMINO DEL MONTE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-3426
Mailing Address - Country:US
Mailing Address - Phone:480-225-9203
Mailing Address - Fax:
Practice Address - Street 1:20414 N 27TH AVE STE 300
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-3254
Practice Address - Country:US
Practice Address - Phone:623-879-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZF01190384207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine