Provider Demographics
NPI:1629663455
Name:G MARCUS FORD MD
Entity Type:Organization
Organization Name:G MARCUS FORD MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-439-4811
Mailing Address - Street 1:15280 ZAHARIAS ST
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-6408
Mailing Address - Country:US
Mailing Address - Phone:909-964-9524
Mailing Address - Fax:888-408-1572
Practice Address - Street 1:12258 PERRIS BLVD
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-7418
Practice Address - Country:US
Practice Address - Phone:909-964-9524
Practice Address - Fax:888-408-1572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty