Healthcare Provider Details

I. General information

NPI: 1376618033
Provider Name (Legal Business Name): DEBRA FORD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBBIE FORD

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 S 52ND ST
TEMPE AZ
85281-9500
US

IV. Provider business mailing address

4722 N AVENIDA DE FRANELAH
TUCSON AZ
85749-9510
US

V. Phone/Fax

Practice location:
  • Phone: 480-784-1514
  • Fax:
Mailing address:
  • Phone: 520-330-1968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25141
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number25141
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: