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General NPI Number Information
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NPI Number | 1326342304
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Entity Type | Organization
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Legal Business Name | JERALD M. FORD, M.D., PSC
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Dates
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Enumeration Date | 01/05/2011
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Last Update Date | 01/05/2011
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Provider Practice Location Address
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Address Line | 617 23RD ST SUITE 415
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City | ASHLAND
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State | KY
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Zip | 41101-2880
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Country | US
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Telephone | 606-325-1200
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Fax | 606-324-9348
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Provider Business Mailing Address
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Address Line | PO BOX 2527
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City | ASHLAND
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State | KY
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Zip | 41105-2527
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Country | US
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Telephone | 606-325-1200
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Fax | 606-324-9348
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Authorized Official
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Title or Position | PRESIDENT
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Name | JERALD M FORD
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Credential | M.D.
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Telephone | 606-325-1200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 15865
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License Number State | KY
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