=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609143379
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADAM JAMES WARD DVM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/24/2011
-----------------------------------------------------
Last Update Date | 07/02/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2414 MONTANA AVE
-----------------------------------------------------
City | SUN PRAIRIE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53590-1617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-305-2868
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 725 N THOMPSON DR
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53704-7836
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-305-2868
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174M00000X
-----------------------------------------------------
Taxonomy Name | Veterinarian
-----------------------------------------------------
License Number | 6658-050
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------