MEDICARE: DR. BRIAN EDWIN WARD PHD

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	246ZG1000X	Medical Geneticist (PhD) Specialist/Technologist

General Provider Information

NPI Number	:	1083685838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN EDWIN WARD PHD

Provider Business Mailing Address
First Line	:	1563 AERIE DR
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84060-8816
Country	:	US
Telephone Number	:	435-649-7380
Fax Number	:	801-584-3640

Provider Business Practice Location Address
First Line	:	320 WAKARA WAY
Second Line	:	MYRIAD GENETIC LABORATORIES INC
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1214
Country	:	US
Telephone Number	:	801-584-1109
Fax Number	:	801-883-3472

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

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	07/08/2007

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