Basic Information
| Provider Information | |||||||||
| NPI: | 1124229901 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FORD-GLANTON | ||||||||
| FirstName: | BENERANDA | ||||||||
| MiddleName: | SOPHIA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 WEST LINCOLN STREET | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | BELLEVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6186415803 | ||||||||
| FaxNumber: | 6186415813 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 W LINCOLN ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | BELLEVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622201901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6186415803 | ||||||||
| FaxNumber: | 6186415813 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2007 | ||||||||
| LastUpdateDate: | 08/23/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 036119047 | IL | Y | Allopathic & Osteopathic Physicians | Urology |
No ID Information.