Provider Demographics
NPI:1952345365
Name:FORD, LESA (MD)
Entity Type:Individual
Prefix:DR
First Name:LESA
Middle Name:
Last Name:FORD
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 1:1600 SCRIPTURE ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-3809
Mailing Address - Country:US
Mailing Address - Phone:940-384-6200
Mailing Address - Fax:940-382-7680
Practice Address - Street 1:1600 SCRIPTURE ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-3809
Practice Address - Country:US
Practice Address - Phone:940-384-6200
Practice Address - Fax:940-382-7680
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5051207ZP0102X
OK16804207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116821302Medicaid
OK100167790AMedicaid
TXE14638Medicare UPIN
OK247226101Medicare PIN
TX116821302Medicaid