MEDICARE: DR. LESA 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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	G5051	TX
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	16804	OK

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952345365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESA FORD M.D.

Provider Business Mailing Address
First Line	:	1600 SCRIPTURE ST
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76201-3809
Country	:	US
Telephone Number	:	940-384-6200
Fax Number	:	940-382-7680

Provider Business Practice Location Address
First Line	:	1600 SCRIPTURE ST
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76201-3809
Country	:	US
Telephone Number	:	940-384-6200
Fax Number	:	940-382-7680

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	07/28/2014

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