Individual
CLYDE DEJONG FORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8 TH AVENUE AND C ST, BONE MARROW TRANSPLANT, SALT LAKE CITY, UT 84143-0001
(801) 408-3729
(801) 408-8453
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(801) 535-8163
(801) 355-4011
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
158790-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107005107110
SELECT HEALTH
UT
01
—
296662
ALTIUS
UT
01
—
6891
DMBA
UT
01
—
91515
PEHP
UT
Enumeration date
07/10/2006
Last updated
08/26/2011
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