Provider Demographics
NPI:1790753242
Name:FORD, ROBERT EMIL (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:EMIL
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 1:2828 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-5103
Mailing Address - Country:US
Mailing Address - Phone:941-925-9355
Mailing Address - Fax:941-925-9359
Practice Address - Street 1:2828 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-5103
Practice Address - Country:US
Practice Address - Phone:941-925-9355
Practice Address - Fax:941-925-9359
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0063089207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E24466Medicare UPIN
FLK6251Medicare ID - Type Unspecified