Provider Demographics
NPI:1487738431
Name:FORD, ALLEN MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:MICHAEL
Last Name:FORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 OAKS WAY
Mailing Address - Street 2:509
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-5394
Mailing Address - Country:US
Mailing Address - Phone:954-366-3899
Mailing Address - Fax:
Practice Address - Street 1:3505 OAKS WAY
Practice Address - Street 2:509
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-5394
Practice Address - Country:US
Practice Address - Phone:954-366-3899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58135207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D80781Medicare UPIN