Provider Demographics
NPI:1134296577
Name:FORD, EDWARD G (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:G
Last Name:FORD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6600 S YALE AVE
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3347
Mailing Address - Country:US
Mailing Address - Phone:918-488-6687
Mailing Address - Fax:918-488-6098
Practice Address - Street 1:6151 S YALE AVE
Practice Address - Street 2:SUITE 1305
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1907
Practice Address - Country:US
Practice Address - Phone:918-494-9450
Practice Address - Fax:918-494-9437
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2017-07-27
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Provider Licenses
StateLicense IDTaxonomies
MO117899208600000X, 2086S0120X
OK284322086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200335580AMedicaid
MO2038833400Medicaid
MO2038833400Medicaid
OK200335580AMedicaid