Healthcare Provider Details

I. General information

NPI: 1932216694
Provider Name (Legal Business Name): JEFFREY WARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 01/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 KAPIOLANI BLVD SUITE 1113
HONOLULU HI
96814-4402
US

IV. Provider business mailing address

1441 KAPIOLANI BLVD SUITE 1113
HONOLULU HI
96814-4402
US

V. Phone/Fax

Practice location:
  • Phone: 808-369-7179
  • Fax:
Mailing address:
  • Phone: 808-369-7179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD427037
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME99403
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: