Provider Demographics
NPI:1932103835
Name:FORD, DORIS ELAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:DORIS
Middle Name:ELAINE
Last Name:FORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 610393
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75261-0393
Mailing Address - Country:US
Mailing Address - Phone:903-291-6187
Mailing Address - Fax:903-237-1810
Practice Address - Street 1:2901 N 4TH STREET
Practice Address - Street 2:HOSPITALIST
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605
Practice Address - Country:US
Practice Address - Phone:903-758-1818
Practice Address - Fax:903-232-8226
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6381207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160276508Medicaid