Healthcare Provider Details

I. General information

NPI: 1841218690
Provider Name (Legal Business Name): RICHARD EDWARD WARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3941 J ST 362
SACRAMENTO CA
95819-3633
US

IV. Provider business mailing address

3941 J ST 362
SACRAMENTO CA
95819-3633
US

V. Phone/Fax

Practice location:
  • Phone: 916-733-0660
  • Fax: 916-733-0664
Mailing address:
  • Phone: 916-733-0660
  • Fax: 916-733-0664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberC036882
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: