Basic Information
| Provider Information | |||||||||
| NPI: | 1659404952 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FORD | ||||||||
| FirstName: | WILLIAM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 205 S MAIN ST | ||||||||
| Address2: | SUITE C | ||||||||
| City: | LONGMONT | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805011716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037021612 | ||||||||
| FaxNumber: | 3037747899 | ||||||||
| Practice Location | |||||||||
| Address1: | 205 S MAIN ST | ||||||||
| Address2: | SUITE C | ||||||||
| City: | LONGMONT | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805011716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037021612 | ||||||||
| FaxNumber: | 3037747899 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 363LX0106X | 66841 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Occupational Health |
No ID Information.