Healthcare Provider Details

I. General information

NPI: 1346491750
Provider Name (Legal Business Name): ROBERT HENDON WARD III C.P.O. / L.P.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2008
Last Update Date: 10/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 NE 13TH ST PROSTHETICS RM 1B100
OKLAHOMA CITY OK
73104-5007
US

IV. Provider business mailing address

921 NE 13TH ST PROSTHETICS RM 1B100
OKLAHOMA CITY OK
73104-5007
US

V. Phone/Fax

Practice location:
  • Phone: 405-456-3854
  • Fax: 405-456-1352
Mailing address:
  • Phone: 405-456-3854
  • Fax: 405-456-1352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number61
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number61
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number61
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: