Provider Demographics
NPI:1396747846
Name:FORD, HALDEN H (MD)
Entity type:Individual
Prefix:
First Name:HALDEN
Middle Name:H
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 1:3101 PARISA DR
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-4584
Mailing Address - Country:US
Mailing Address - Phone:270-444-8477
Mailing Address - Fax:270-444-8479
Practice Address - Street 1:3101 PARISA DR
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-4584
Practice Address - Country:US
Practice Address - Phone:270-444-8477
Practice Address - Fax:270-444-8479
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32680207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64326804Medicaid
KY64326804Medicaid
KYF94012Medicare UPIN