Provider Demographics
NPI:1992223812
Name:FORD, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:FORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 RUE FELICITE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70507-5648
Mailing Address - Country:US
Mailing Address - Phone:337-781-7778
Mailing Address - Fax:
Practice Address - Street 1:323 PATTERSON ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-2859
Practice Address - Country:US
Practice Address - Phone:337-233-1154
Practice Address - Fax:337-233-1154
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-30
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator