Provider Demographics
NPI:1972588804
Name:FORD, GERALD P (MD)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:P
Last Name:FORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2600 S RURAL RD STE B
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-2448
Mailing Address - Country:US
Mailing Address - Phone:480-967-3381
Mailing Address - Fax:480-967-0755
Practice Address - Street 1:2600 S RURAL RD STE B
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-2448
Practice Address - Country:US
Practice Address - Phone:480-967-3381
Practice Address - Fax:480-967-0755
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ7813207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ180005504OtherRAILROAD MEDICARE
AZ246706Medicaid
AZAZ0017680OtherBLUE CROSS BLUE SHIELD
AZAZ0017680OtherBLUE CROSS BLUE SHIELD