Individual
DR. MARY N FORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3344 N FUTRALL DR, FAYETTEVILLE, AR 72703-4057
(479) 521-8200
(479) 582-7310
Mailing address
PO BOX 1523, FAYETTEVILLE, AR 72702-1523
(479) 571-6038
(479) 582-0222
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
E-10346
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000003911
TENNCARE TLC
TN
01
—
3062741
BLUE CROSS
TN
05
—
3388963
—
TN
Enumeration date
11/17/2005
Last updated
03/14/2024
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