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Ford, Derek Thomas

CPSO#: 72358

MEMBER STATUS

Active Member as of 05 May 2004

CURRENT OR PAST CPSO REGISTRATION CLASS

Independent Practice as of 05 May 2004

Summary

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Former Name: Brzozowski, Dariusz (used until: 10 Oct 2001 )

Gender: Male

Languages Spoken: English, Polish

Education: Schulich School of Medicine and Dentistr, 1998

Practice Information

Primary Location of Practice

7 St Thomas Street
Suite 410
Toronto ON M5S 2B7
Phone: (416) 925-7337
Fax: (416) 928-0716 Electoral District: 10

Additional Practice Location(s)

Oshawa Centre
Executive Tower
Suite 305
419 King Street West
Oshawa ON L1J 2K5
Canada
Phone: (905) 743-9888
Fax: (416) 928-0716
County: Regional Municipality of Durham
Electoral District: 05

Professional Corporation Information

Corporation Name: Derek T Ford Medicine Professional Corporation
Certificate of Authorization Status: Issued Date: Sep 14 2004

Shareholders:
Dr. D. Ford ( CPSO# 72358 )

Business Address:
Suite 410
7 St. Thomas Street
Toronto ON M5S 2B7
Phone Number: (888) 925-7337

Business Address:
Oshawa Centre
Executive Tower
305 - 419 King Street West
Oshawa ON L1J 2K4

Hospital Privileges

Hospital	Location
Lakeridge Health,Clarington Site	Bowmanville
Lakeridge Health,Oshawa General Site	Oshawa

Specialties

Specialty	Issued On	Type
Plastic Surgery	Effective:30 Jun 2003	RCPSC Specialist

Terms and Conditions

(1) Dr. DEREK THOMAS FORD may practise only in the areas of medicine in which Dr. FORD is educated and experienced.

Postgraduate Training

Please note: This information may not be a complete record of postgraduate training.

Schulich School of Medicine and Dentistr, 01 Jul 1998 to 30 Jun 1999
PostGrad Yr 1 - Plastic Surgery

Schulich School of Medicine and Dentistr, 01 Jul 1999 to 30 Jun 2000
PostGrad Yr 2 - Plastic Surgery

Schulich School of Medicine and Dentistr, 01 Jul 2000 to 30 Jun 2001
PostGrad Yr 3 - Plastic Surgery

Schulich School of Medicine and Dentistr, 01 Jul 2001 to 30 Jun 2002
PostGrad Yr 4 - Plastic Surgery

Schulich School of Medicine and Dentistr, 01 Jul 2002 to 30 Jun 2003
PostGrad Yr 5 - Plastic Surgery

Registration History

Action	Issue Date
First certificate of registration issued: Postgraduate Education Certificate	Effective: 01 Jul 1998
Expired: Terms and conditions of certificate of registration	Expiry: 30 Jun 2003
Subsequent certificate of registration Issued: Independent Practice Certificate	Effective: 05 May 2004