Healthcare Provider Details

I. General information

NPI: 1821044025
Provider Name (Legal Business Name): GREGORY WARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8338 SUMMA AVE SUITE 500
BATON ROUGE LA
70809-3669
US

IV. Provider business mailing address

PO BOX 84330
BATON ROUGE LA
70884-4330
US

V. Phone/Fax

Practice location:
  • Phone: 225-766-1616
  • Fax: 225-766-2645
Mailing address:
  • Phone: 225-766-1616
  • Fax: 225-766-2645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number08510R
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number032835
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: