Healthcare Provider Details

I. General information

NPI: 1366490286
Provider Name (Legal Business Name): DERRICK ROBERT WARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8675 COLLEGE BLVD SUITE 200
OVERLAND PARK KS
66210-1835
US

IV. Provider business mailing address

8675 COLLEGE BLVD SUITE 200
OVERLAND PARK KS
66210-1835
US

V. Phone/Fax

Practice location:
  • Phone: 913-491-5501
  • Fax: 913-491-8901
Mailing address:
  • Phone: 913-491-5501
  • Fax: 913-491-8901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number2003009413
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: