MEDICARE: DR. JOSEPH MILLARD WARD PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY2940	FL

General Provider Information

NPI Number	:	1033390307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH MILLARD WARD PH.D.

Provider Business Mailing Address
First Line	:	10901 BURNT MILL RD
Second Line	:	#1303
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-2872
Country	:	US
Telephone Number	:	904-403-1391
Fax Number	:

Provider Business Practice Location Address
First Line	:	10901 BURNT MILL RD
Second Line	:	#1303
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-2872
Country	:	US
Telephone Number	:	904-403-1391
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2007
Last Update Date	:	11/15/2007

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