Healthcare Provider Details

I. General information

NPI: 1649250150
Provider Name (Legal Business Name): DAVID CHRISTAIN FORD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 06/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 E 19TH ST
THE DALLES OR
97058-3317
US

IV. Provider business mailing address

923 E 18TH ST
THE DALLES OR
97058-2831
US

V. Phone/Fax

Practice location:
  • Phone: 541-296-7235
  • Fax:
Mailing address:
  • Phone: 503-673-9302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD25653
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: