Healthcare Provider Details

I. General information

NPI: 1558702423
Provider Name (Legal Business Name): JONATHAN WARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 07/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 HIGHLAND AVE
BOULDER CO
80302-4717
US

IV. Provider business mailing address

429 HIGHLAND AVE
BOULDER CO
80302-4717
US

V. Phone/Fax

Practice location:
  • Phone: 303-997-6412
  • Fax:
Mailing address:
  • Phone: 303-997-6412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174V00000X
TaxonomyClinical Ethicist
License Number20052
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number20052
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: