Healthcare Provider Details

I. General information

NPI: 1679260558
Provider Name (Legal Business Name): JEFFREY LOREN WARD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JEFF LOREN WARD DO

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 SE BISHOP BLVD STE 401
PULLMAN WA
99163-5517
US

IV. Provider business mailing address

825 SE BISHOP BLVD STE 401
PULLMAN WA
99163-5517
US

V. Phone/Fax

Practice location:
  • Phone: 509-336-7720
  • Fax:
Mailing address:
  • Phone: 509-336-7720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOL61446543
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: