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General NPI Number Information
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NPI Number | 1376568808
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Entity Type | Individual
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Provider Name | KIMBERLY JO FORDHAM MD
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Gender | Female
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 01/06/2010
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Provider Practice Location Address
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Address Line | 21337 BUSH STREET
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City | MIDDLETOWN
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State | CA
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Zip | 95461-1519
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Country | US
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Telephone | 707-987-3311
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Fax | 707-987-2455
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Provider Business Mailing Address
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Address Line | PO BOX 1519 21337 BUSH STREET
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City | MIDDLETOWN
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State | CA
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Zip | 95461-1519
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Country | US
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Telephone | 707-987-3311
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Fax | 707-987-2455
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A78858
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License Number State | CA
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