Healthcare Provider Details

I. General information

NPI: 1205940830
Provider Name (Legal Business Name): THEODORE ROWE FORD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2542 NE COURTNEY DR STE 200G
BEND OR
97701-7684
US

IV. Provider business mailing address

2542 NE COURTNEY DR STE 200G
BEND OR
97701-7684
US

V. Phone/Fax

Practice location:
  • Phone: 541-647-1645
  • Fax: 541-647-1648
Mailing address:
  • Phone: 541-647-1645
  • Fax: 541-647-1648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberMD19247
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD19247
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: