1831174531 NPI number — L BRUCE FORD DPM

Table of content: L BRUCE FORD DPM (NPI 1831174531)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831174531 NPI number — L BRUCE FORD DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FORD
Provider First Name:
L
Provider Middle Name:
BRUCE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831174531
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2321 PYRAMID WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPARKS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89431-8700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-331-2321
Provider Business Mailing Address Fax Number:
775-331-2008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2321 PYRAMID WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARKS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89431-8700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-331-2321
Provider Business Practice Location Address Fax Number:
775-331-2008
Provider Enumeration Date:
12/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  23 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 480480550 . This is a "MRR" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: CH8729 . This is a "RR GROUP PROVIDER # - EXPIRED 2/17/2008" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 211603 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 490001810 . This is a "RR INDIVIDUAL PROV # - EXPIRED 2/17/2008" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




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