Provider Demographics
NPI:1811986193
Name:FORD, GERALD H (CRNA)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:H
Last Name:FORD
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5409
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79608-5409
Mailing Address - Country:US
Mailing Address - Phone:325-793-5380
Mailing Address - Fax:325-793-5259
Practice Address - Street 1:4400 BUFFALO GAP RD
Practice Address - Street 2:SUITE 2250
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-2723
Practice Address - Country:US
Practice Address - Phone:325-793-5380
Practice Address - Fax:325-793-5259
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX038581367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00342697OtherMEDICARE ID
TX86009UOtherBCBSTX
TXC088724C5Medicaid
TX88724CMedicare ID - Type Unspecified
TXC088724C5Medicaid