Provider Demographics
NPI:1679680532
Name:FORD, ALAN KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:KEITH
Last Name:FORD
Suffix:
Gender:M
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:PO BOX 1441
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79105-1441
Mailing Address - Country:US
Mailing Address - Phone:509-586-5779
Mailing Address - Fax:509-586-5178
Practice Address - Street 1:900 S AUBURN STREET
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-5621
Practice Address - Country:US
Practice Address - Phone:509-586-5779
Practice Address - Fax:509-586-5178
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000166662085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8560401Medicaid
WA8869952Medicare PIN
A09400Medicare UPIN
WA8560401Medicaid