THEODORE R FORD MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036086055

License Status

INACTIVE

Business

First Name

THEODORE R

Last Name

FORD

Suffix

Business Name

THEODORE R FORD MD

Original Issue Date

05/17/1993

Effective Date

05/17/1993

Expiration Date

07/31/1996

City

BEND

State

Zip

97701

County

OREGON

Ever Disciplined

LastModifiedDate

09/20/2006