Healthcare Provider Details

I. General information

NPI: 1417059924
Provider Name (Legal Business Name): JACK O FORD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W GOLD ST
BUTTE MT
59701-2320
US

IV. Provider business mailing address

700 W GOLD ST
BUTTE MT
59701-2320
US

V. Phone/Fax

Practice location:
  • Phone: 406-782-6391
  • Fax: 406-782-6585
Mailing address:
  • Phone: 406-782-6391
  • Fax: 406-782-6585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number10733
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: