Individual
DR. CHARLES R FORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1815 E 19TH ST, SUITE 1, THE DALLES, OR 97058-3385
(541) 298-5563
(541) 298-7746
Mailing address
1815 E 19TH ST, SUITE 1, THE DALLES, OR 97058-3385
(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
—
064899
—
OR
01
—
1313907
MEDICAID
WA
01
—
831523001
REGENCE BLUE CROSS OF OR
OR
01
—
P00139667
RAILROAD MEDICARE
—
Enumeration date
09/25/2006
Last updated
08/26/2009
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