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General NPI Number Information
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NPI Number | 1629663455
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Entity Type | Organization
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Legal Business Name | G MARCUS FORD MD
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Dates
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Enumeration Date | 03/03/2021
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Last Update Date | 03/03/2021
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Provider Practice Location Address
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Address Line | 12258 PERRIS BLVD
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City | MORENO VALLEY
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State | CA
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Zip | 92557-7418
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Country | US
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Telephone | 909-964-9524
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Fax | 888-408-1572
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Provider Business Mailing Address
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Address Line | 15280 ZAHARIAS ST
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City | MORENO VALLEY
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State | CA
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Zip | 92555-6408
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Country | US
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Telephone | 909-964-9524
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Fax | 888-408-1572
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Authorized Official
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Title or Position | OWNER
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Name | GLENN FORD
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Credential | MD
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Telephone | 323-439-4811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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