Healthcare Provider Details

I. General information

NPI: 1023080900
Provider Name (Legal Business Name): WILLIAM R. FORD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N 3RD ST
PONCA CITY OK
74601-4335
US

IV. Provider business mailing address

212 N MAIN ST
FAIRFAX OK
74637-3023
US

V. Phone/Fax

Practice location:
  • Phone: 580-767-1777
  • Fax: 580-762-2917
Mailing address:
  • Phone: 918-642-3100
  • Fax: 918-642-5639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberL6382
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: