MEDICARE: KAREN GOFF FORD LMT

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	174400000X	Specialist	MA19505	FL

General Provider Information

NPI Number	:	1952647158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN GOFF FORD LMT

Provider Business Mailing Address
First Line	:	252 W MARION AVE
Second Line	:	SUITE 1124
City	:	PUNTA GORDA
State	:	FL
Zip	:	33950-4442
Country	:	US
Telephone Number	:	941-286-6399
Fax Number	:

Provider Business Practice Location Address
First Line	:	252 W MARION AVE
Second Line	:	SUITE 1124
City	:	PUNTA GORDA
State	:	FL
Zip	:	33950-4442
Country	:	US
Telephone Number	:	941-286-6399
Fax Number	:

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

Provider Enumeration Date	:	12/17/2012
Last Update Date	:	12/17/2012

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