Organization
COLUMBIA GORGE ENT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES R FORD MD (OWNER)
(541) 298-5563
Entity
Organization
Contact information
Practice address
1815 E 19TH ST, SUITE 1, THE DALLES, OR 97058-3365
(541) 298-5563
(541) 298-7746
Mailing address
1815 E 19TH ST, SUITE 1, THE DALLES, OR 97058-3365
(541) 298-5563
(541) 298-7746
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
MD10654
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022888
—
OR
05
—
7124860
—
WA
01
—
DB9629
RAILROAD MEDICARE
OR
Enumeration date
07/13/2005
Last updated
08/23/2007
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