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NPI Code Detail

MEDICARE: JANICE MARIE FORDHAM M.D.

MEDICARE: JANICE MARIE FORDHAM M.D.
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
1207Q00000XFamily Medicine Physician26048MT

General Provider Information

NPI Number : 1609197433
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANICE MARIE FORDHAM M.D.
Provider Business Mailing Address
First Line : 1035 1ST AVE
Second Line :
City : LAUREL
State : MT
Zip : 59044-2119
Country : US
Telephone Number : 406-628-6311
Fax Number :
Provider Business Practice Location Address
First Line : 1035 1ST AVE
Second Line :
City : LAUREL
State : MT
Zip : 59044-2119
Country : US
Telephone Number : 406-628-6311
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2010
Last Update Date : 05/12/2014

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