MEDICARE: ANDREA P FORD DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	2008-00212	NC
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207Q00000X	Family Medicine Physician	S4285	TX

General Provider Information

NPI Number	:	1447473046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA P FORD DO

Provider Business Mailing Address
First Line	:	2005 FORT WORTH HWY STE 100
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-4780
Country	:	US
Telephone Number	:	817-598-5625
Fax Number	:

Provider Business Practice Location Address
First Line	:	2005 FORT WORTH HWY STE 100
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-4780
Country	:	US
Telephone Number	:	817-598-5625
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	10/29/2020

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