MEDICARE: SAMUEL ENOCH WARD DO

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	DO3663	NV
2	390200000X	Student in an Organized Health Care Education/Training Program

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	DO3663	OTHER	NV	LICENSE

General Provider Information

NPI Number	:	1063975225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL ENOCH WARD DO

Provider Business Mailing Address
First Line	:	6355 S BUFFALO DR FL 3
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-2133
Country	:	US
Telephone Number	:	702-216-3346
Fax Number	:

Provider Business Practice Location Address
First Line	:	8350 W BADURA AVE 3RD FL
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113
Country	:	US
Telephone Number	:	702-304-5726
Fax Number	:	702-949-6200

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

Provider Enumeration Date	:	04/12/2019
Last Update Date	:	06/08/2026

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