Healthcare Provider Details

I. General information

NPI: 1336111418
Provider Name (Legal Business Name): DAVID RUSSELL WARD AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 PROSPECT AVE NE STE C
ALBUQUERQUE NM
87110-4283
US

IV. Provider business mailing address

5005 PROSPECT AVE NE STE C
ALBUQUERQUE NM
87110-4283
US

V. Phone/Fax

Practice location:
  • Phone: 505-295-1770
  • Fax:
Mailing address:
  • Phone: 505-295-1770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number80349
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: