Provider Demographics
NPI:1659485357
Name:FORD, JERALD M (MD)
Entity type:Individual
Prefix:DR
First Name:JERALD
Middle Name:M
Last Name:FORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2379
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2379
Mailing Address - Country:US
Mailing Address - Phone:606-408-6200
Mailing Address - Fax:606-408-6612
Practice Address - Street 1:2245 WINCHESTER AVE STE 1
Practice Address - Street 2:SUITE 150
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7848
Practice Address - Country:US
Practice Address - Phone:606-324-2554
Practice Address - Fax:606-324-2581
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY15865207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYC69118Medicare UPIN
1226101Medicare ID - Type Unspecified
KY000000049192OtherANTHEM