Individual
DR. CHARLES R FORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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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