Provider Demographics
NPI:1912929746
Name:FORD, THOMAS B (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:B
Last Name:FORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4150 NELSON RD
Mailing Address - Street 2:BLDG G, STE 1
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-4148
Mailing Address - Country:US
Mailing Address - Phone:337-310-0440
Mailing Address - Fax:337-310-0444
Practice Address - Street 1:4150 NELSON RD
Practice Address - Street 2:BLDG G, STE 1
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-4148
Practice Address - Country:US
Practice Address - Phone:337-310-0440
Practice Address - Fax:337-310-0444
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA014735207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
2194951OtherAETNA
LAF8124OtherBLUE CROSS / BLUE SHIELD
0371590001Medicare NSC
51176Medicare PIN