Healthcare Provider Details

I. General information

NPI: 1902093800
Provider Name (Legal Business Name): JOHN P. WARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7531 SENECA ST
EAST AURORA NY
14052
US

IV. Provider business mailing address

7531 SENECA ST
EAST AURORA NY
14052-9407
US

V. Phone/Fax

Practice location:
  • Phone: 716-655-5019
  • Fax: 716-655-1567
Mailing address:
  • Phone: 716-655-5019
  • Fax: 716-655-1567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1714051
License Number StateNY

VIII. Authorized Official

Name: JOHN P. WARD
Title or Position: DOCTOR
Credential: D.O.
Phone: 716-655-5019