Healthcare Provider Details

I. General information

NPI: 1609397405
Provider Name (Legal Business Name): DEVON BROOKE WARD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2017
Last Update Date: 07/21/2022
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 W HERNDON AVE STE 108
FRESNO CA
93722-8401
US

IV. Provider business mailing address

9300 VALLEY CHILDRENS PL
MADERA CA
93636-8761
US

V. Phone/Fax

Practice location:
  • Phone: 559-256-7990
  • Fax: 559-256-7991
Mailing address:
  • Phone: 559-353-5700
  • Fax: 559-353-5708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA158273
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: