Provider Demographics
NPI:1740276955
Name:FORD, LORI JANINE (MD)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:JANINE
Last Name:FORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:384 S 33RD ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-5065
Mailing Address - Country:US
Mailing Address - Phone:918-682-0700
Mailing Address - Fax:918-682-7317
Practice Address - Street 1:384 S 33RD ST
Practice Address - Street 2:SUITE B
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-5065
Practice Address - Country:US
Practice Address - Phone:918-682-0700
Practice Address - Fax:918-682-7317
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK19431207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100014379OtherRRMC
OK50178555001OtherBCBS
OK10086280AMedicaid
OK50178555001OtherBCBS