Provider Demographics
NPI:1558623447
Name:FORD, BRIAN SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:SCOTT
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:PSC 490
Mailing Address - Street 2:BOX 7638
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96538-0490
Mailing Address - Country:US
Mailing Address - Phone:671-344-9461
Mailing Address - Fax:
Practice Address - Street 1:50 FARENHOLT AVE
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3106
Practice Address - Country:US
Practice Address - Phone:671-929-1139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101255199207Q00000X
GUM1930207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine