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General NPI Number Information
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NPI Number | 1639600232
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Entity Type | Individual
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Provider Name | TABITHA FORD MD
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Gender | Female
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Dates
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Enumeration Date | 03/24/2017
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Last Update Date | 07/13/2020
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Provider Practice Location Address
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Address Line | 111 COLCHESTER AVE
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City | BURLINGTON
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State | VT
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Zip | 05401-1473
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Country | US
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Telephone | 802-847-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 30 N 1900 E # 1C026
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City | SALT LAKE CITY
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State | UT
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Zip | 84132-7619
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Country | US
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Telephone | 801-581-2730
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 303862
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 10957064-1205
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 042-0014745
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License Number State | VT
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