Healthcare Provider Details

I. General information

NPI: 1811005317
Provider Name (Legal Business Name): WARD M PRENTICE PA C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 FM 517 WEST
DICKINSON TX
77539
US

IV. Provider business mailing address

914 FM 517 WEST
DICKINSON TX
77539
US

V. Phone/Fax

Practice location:
  • Phone: 281-337-1512
  • Fax: 281-534-1472
Mailing address:
  • Phone: 281-337-1512
  • Fax: 281-534-1472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberPA01820
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: