Healthcare Provider Details

I. General information

NPI: 1942208301
Provider Name (Legal Business Name): PHILIP EUGENE WARD PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 03/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 HILLCREST ST
ORLANDO FL
32801-1211
US

IV. Provider business mailing address

335 GLESSNER AVE MEDCENTRAL HEALTH SERVICES
MANSZFIELD OH
44903
US

V. Phone/Fax

Practice location:
  • Phone: 407-425-1566
  • Fax: 407-422-0166
Mailing address:
  • Phone: 407-425-1566
  • Fax: 407-422-0166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA2907
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: