Healthcare Provider Details

I. General information

NPI: 1518933381
Provider Name (Legal Business Name): R. CRAIG FORD AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 10/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 VALLEY RIVER DR STE 395
EUGENE OR
97401-2129
US

IV. Provider business mailing address

1600 VALLEY RIVER DR STE 395
EUGENE OR
97401-2132
US

V. Phone/Fax

Practice location:
  • Phone: 541-689-2107
  • Fax: 541-689-2107
Mailing address:
  • Phone: 541-689-2107
  • Fax: 541-743-4179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number20567
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier139532
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerMEDICARE PTAN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: