Healthcare Provider Details

I. General information

NPI: 1174742688
Provider Name (Legal Business Name): E FRAZIER WARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 06/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NORTH STATE STREET ORTHOPAEDIC SURGERY
JACKSON MS
39216
US

IV. Provider business mailing address

2500 NORTH STATE STREET ORTHOPAEDIC SURGERY
JACKSON MS
39216
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-6525
  • Fax: 601-984-5151
Mailing address:
  • Phone: 601-984-6525
  • Fax: 601-984-5151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number05169
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number05169
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: