Healthcare Provider Details

I. General information

NPI: 1134296577
Provider Name (Legal Business Name): EDWARD G. FORD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6151 S YALE AVE SUITE 1305
TULSA OK
74136-1907
US

IV. Provider business mailing address

6600 S YALE AVE SUITE 1200
TULSA OK
74136-3347
US

V. Phone/Fax

Practice location:
  • Phone: 918-494-9450
  • Fax: 918-494-9437
Mailing address:
  • Phone: 918-488-6687
  • Fax: 918-488-6098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number117899
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number117899
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number28432
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: