Individual
KEITH BRADLEY FORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2410 SAMARITAN DR, SUITE 101, SAN JOSE, CA 95124-3909
(408) 371-0390
(408) 371-0462
Mailing address
2410 SAMARITAN DR, SUITE 101, SAN JOSE, CA 95124-3909
(408) 371-0390
(408) 371-0462
Taxonomy
Speciality
Code
Description
License number
State
2085N0904X
Nuclear Radiology Physician
G42474
CA
2085R0202X
Diagnostic Radiology Physician
Primary
G42474
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G424740
—
CA
Enumeration date
08/05/2006
Last updated
03/27/2012
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