Doctor Name: | MR. JEFF W FORDHAM |
NPI Number: | 1033305909 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | ARDMS |
License Number: | ARDMS 12496 |
Business Practice Address: | 3040 Moser Dome Rd Silesia, MT - 590419607 |
Business Phone Number: | 4066287980 |
Business Fax Number: | |
Mailing Address: | 3040 Moser Dome Rd, SILESIA |
State: | MT |
Postal Code: | 590419607 |
Phone Number: | 4066287980 |
Fax Number: | |
NPI Enumeration Date: | 09/24/2007 |
NPI Last Update Date: | 09/24/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2471S1302X |
License Number: | ARDMS 12496 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
Taxonomy Classification: | Radiologic Technologist |
Taxonomy Specialization: | Sonography |
Taxonomy Definition: |