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General NPI Number Information
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NPI Number | 1144504978
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Entity Type | Organization
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Legal Business Name | RENATA FORD MD PA
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Dates
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Enumeration Date | 09/28/2011
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Last Update Date | 09/28/2011
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Provider Practice Location Address
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Address Line | 502 MADISON OAK DR SUITE 160
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City | SAN ANTONIO
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State | TX
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Zip | 78258-4084
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Country | US
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Telephone | 210-519-5797
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 691475
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City | SAN ANTONIO
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State | TX
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Zip | 78269-1475
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MD OWNER
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Name | RENATA FORD
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Credential | MD
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Telephone | 210-705-4855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number |
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License Number State |
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