Provider Demographics
NPI:1881910149
Name:LEDFORD, JODIANN (MD)
Entity type:Individual
Prefix:
First Name:JODIANN
Middle Name:
Last Name:LEDFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-2354
Mailing Address - Country:US
Mailing Address - Phone:442-347-2800
Mailing Address - Fax:858-634-6983
Practice Address - Street 1:750 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-2354
Practice Address - Country:US
Practice Address - Phone:442-347-2800
Practice Address - Fax:858-634-6983
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD20058208000000X
390200000X
CAA120777208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program