Healthcare Provider Details

I. General information

NPI: 1376673723
Provider Name (Legal Business Name): DOUG FORD N.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HCR1 5762
KEAAU HI
96749
US

IV. Provider business mailing address

17-1654 41ST AVE.
KEAAU HI
96749
US

V. Phone/Fax

Practice location:
  • Phone: 808-345-2235
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND 058
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: