MEDICARE: WILLIAM R. FORD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	L6382	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023080900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM R. FORD M.D.

Provider Business Mailing Address
First Line	:	212 N MAIN ST
Second Line	:
City	:	FAIRFAX
State	:	OK
Zip	:	74637-3023
Country	:	US
Telephone Number	:	918-642-3100
Fax Number	:	918-642-5639

Provider Business Practice Location Address
First Line	:	215 N 3RD ST
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74601-4335
Country	:	US
Telephone Number	:	580-767-1777
Fax Number	:	580-762-2917

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	03/07/2023

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Directions to “ WILLIAM R. FORD M.D.” Practice Location

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