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General NPI Number Information
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NPI Number | 1851039762
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Entity Type | Organization
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Legal Business Name | CTD NETWORK LLC
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Dates
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Enumeration Date | 05/23/2022
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Last Update Date | 05/30/2023
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Provider Practice Location Address
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Address Line | 1805 JAMES L REDMAN PKWY STE 201
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City | PLANT CITY
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State | FL
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Zip | 33563-7012
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Country | US
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Telephone | 813-807-3338
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Fax |
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Provider Business Mailing Address
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Address Line | 2501 WALDEN WOODS DR # 5412
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City | PLANT CITY
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State | FL
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Zip | 33566-7168
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Country | US
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Telephone | 813-807-3338
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK FORD
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Credential |
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Telephone | 813-807-3338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 170300000X
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Taxonomy Name | Genetic Counselor (M.S.)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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