Healthcare Provider Details

I. General information

NPI: 1780038539
Provider Name (Legal Business Name): ASHLEY N FORD D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2635 CHANNING WAY
IDAHO FALLS ID
83404-7518
US

IV. Provider business mailing address

2635 CHANNING WAY
IDAHO FALLS ID
83404-7518
US

V. Phone/Fax

Practice location:
  • Phone: 208-535-4343
  • Fax:
Mailing address:
  • Phone: 208-535-4343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberS6835
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: