Healthcare Provider Details

I. General information

NPI: 1114378023
Provider Name (Legal Business Name): WARD MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 06/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6322 S 3000 E SUITE 170
SALT LAKE CITY UT
84121-6922
US

IV. Provider business mailing address

3204 E DEER RIDGE PL
SANDY UT
84092-6553
US

V. Phone/Fax

Practice location:
  • Phone: 801-739-3395
  • Fax:
Mailing address:
  • Phone: 801-739-3395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number327556-1205
License Number StateUT

VIII. Authorized Official

Name: PRESTON DANIEL WARD
Title or Position: OWNER/SURGEON
Credential: M.D.
Phone: 801-739-3395