MEDICARE: DR. MARY N FORD MD

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	207R00000X	Internal Medicine Physician	E-10346	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3062741	OTHER	TN	BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000003911	OTHER	TN	TENNCARE TLC

General Provider Information

NPI Number	:	1356323042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY N FORD MD

Provider Business Mailing Address
First Line	:	PO BOX 1523
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72702-1523
Country	:	US
Telephone Number	:	479-571-6038
Fax Number	:	479-582-0222

Provider Business Practice Location Address
First Line	:	3344 N FUTRALL DR
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703-4057
Country	:	US
Telephone Number	:	479-521-8200
Fax Number	:	479-582-7310

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

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	03/14/2024

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