Healthcare Provider Details

I. General information

NPI: 1023080926
Provider Name (Legal Business Name): ARTHUR WELLS WARD D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 05/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35000 GUADALCANAL AVE MCRD BRANCH MEDICAL CLINIC
SAN DIEGO CA
92140-5599
US

IV. Provider business mailing address

35000 GUADALCANAL AVE MCRD BRANCH MEDICAL CLINIC SMART
SAN DIEGO CA
92140-5599
US

V. Phone/Fax

Practice location:
  • Phone: 619-524-8313
  • Fax:
Mailing address:
  • Phone: 858-353-6246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number016-004248
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: