MEDICARE: DR. TERRY D. 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	207P00000X	Emergency Medicine Physician	12405	MS

General Provider Information

NPI Number	:	1912922949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRY D. FORD M.D.

Provider Business Mailing Address
First Line	:	PO BOX 329
Second Line	:
City	:	BAY SPRINGS
State	:	MS
Zip	:	39422-0329
Country	:	US
Telephone Number	:	601-764-6848
Fax Number	:

Provider Business Practice Location Address
First Line	:	639 HIGHWAY 528
Second Line	:
City	:	BAY SPRINGS
State	:	MS
Zip	:	39422-4823
Country	:	US
Telephone Number	:	601-764-6848
Fax Number	:

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	04/20/2013

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