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General NPI Number Information
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NPI Number | 1306044599
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Entity Type | Organization
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Legal Business Name | REED I. WARD, D.O., P.A.
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 02/24/2020
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Provider Practice Location Address
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Address Line | 3425 POTOMAC WAY
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City | IDAHO FALLS
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State | ID
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Zip | 83404-4984
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Country | US
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Telephone | 208-528-8170
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Fax | 208-522-5461
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Provider Business Mailing Address
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Address Line | 3360 WASHINGTON PKWY STE 2
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City | IDAHO FALLS
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State | ID
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Zip | 83404-8333
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Country | US
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Telephone | 208-528-8170
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Fax | 208-522-5461
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Authorized Official
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Title or Position | OWNER
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Name | REED IVOL WARD
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Credential | D.O.
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Telephone | 208-528-8170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | O-263
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License Number State | ID
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