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Individual

TIMOTHY FORD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
4605 MACCORKLE AVE SW, SOUTH CHARLESTON, WV 25309-1311
(304) 766-3600
Mailing address
11157 CHARLESTON RD, RED HOUSE, WV 25168
(304) 550-1343

Taxonomy

Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
00429
WV

Other

Enumeration date
04/02/2014
Last updated
04/02/2014
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