Provider Demographics
NPI:1699916999
Name:FORD, JUSTIN GUY (DO)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:GUY
Last Name:FORD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8A DORETHY RD
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CT
Mailing Address - Zip Code:06896-2912
Mailing Address - Country:US
Mailing Address - Phone:206-450-4102
Mailing Address - Fax:
Practice Address - Street 1:10 SOUTH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4124
Practice Address - Country:US
Practice Address - Phone:203-431-4600
Practice Address - Fax:203-431-4601
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOL60032175207Q00000X
CT51869207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine