Individual
DONALD R FORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
600 N COLLEGE AVE, SUITE 120, GENESEO, IL 61254-1091
(309) 944-5342
(309) 944-8192
Mailing address
600 N COLLEGE AVE, SUITE 120, GENESEO, IL 61254-1091
(309) 944-5342
(309) 945-4079
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036047661
IL
207Q00000X
Family Medicine Physician
25736
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036047661
—
IL
05
—
0360476613
—
IL
01
—
0801777765
RR MEDICARE
IL
05
—
1053398933
—
IL
Enumeration date
12/30/2005
Last updated
02/05/2015
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