Provider Demographics
NPI:1205940830
Name:FORD, THEODORE ROWE (MD)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:ROWE
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 1:66265 GERKING MARKET RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-9080
Mailing Address - Country:US
Mailing Address - Phone:541-388-7996
Mailing Address - Fax:
Practice Address - Street 1:2542 NE COURTNEY DR STE 200G
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7684
Practice Address - Country:US
Practice Address - Phone:541-647-1645
Practice Address - Fax:541-647-1648
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19247208VP0014X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR072004Medicaid
OR072004Medicaid