Individual
DR. JERRY GLEN FORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2020 FLEISCHMANN RD, TALLAHASSEE, FL 32308-4599
(850) 878-6161
(850) 656-0200
Mailing address
2020 FLEISCHMANN RD, TALLAHASSEE, FL 32308-4599
(850) 878-6161
(850) 656-0200
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
ME050710
GA
207W00000X
Ophthalmology Physician
Primary
ME080121
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00897498A
—
GA
05
—
258638000
—
FL
Enumeration date
06/17/2005
Last updated
05/31/2022
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