Provider Demographics
NPI:1447318357
Name:FORD, SANDRA MATHEWS (MD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:MATHEWS
Last Name:FORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 TUSCALOOSA AVE SW
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35211-1631
Mailing Address - Country:US
Mailing Address - Phone:205-786-1025
Mailing Address - Fax:205-780-0670
Practice Address - Street 1:516 TUSCALOOSA AVE SW
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1631
Practice Address - Country:US
Practice Address - Phone:205-786-1025
Practice Address - Fax:205-780-0670
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4492207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529920170Medicaid
ALE11520Medicare UPIN
AL529920170Medicaid