Basic Information
| Provider Information | |||||||||
| NPI: | 1487940060 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FORD | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1775 W HIBISCUS BLVD | ||||||||
| Address2: | SUITE 215 | ||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329012620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3218373825 | ||||||||
| FaxNumber: | 3218373654 | ||||||||
| Practice Location | |||||||||
| Address1: | 1350 HICKORY ST | ||||||||
| Address2: | |||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329013224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3214347000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2011 | ||||||||
| LastUpdateDate: | 12/31/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 34010661 | OH | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | OS12456 | FL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.