Provider Demographics
NPI:1033305909
Name:FORDHAM, JEFF W (ARDMS)
Entity type:Individual
Prefix:MR
First Name:JEFF
Middle Name:W
Last Name:FORDHAM
Suffix:
Gender:M
Credentials:ARDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 MOSER DOME RD
Mailing Address - Street 2:
Mailing Address - City:SILESIA
Mailing Address - State:MT
Mailing Address - Zip Code:59041-9607
Mailing Address - Country:US
Mailing Address - Phone:406-628-7980
Mailing Address - Fax:
Practice Address - Street 1:3040 MOSER DOME RD
Practice Address - Street 2:
Practice Address - City:SILESIA
Practice Address - State:MT
Practice Address - Zip Code:59041-9607
Practice Address - Country:US
Practice Address - Phone:406-628-7980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARDMS 124962471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography