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NPI Code Detail

MEDICARE: MR. DAVID WARD P.A.

MEDICARE: MR. DAVID WARD P.A.
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
1363A00000XPhysician Assistant458OK

General Provider Information

NPI Number : 1205864279
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DAVID WARD P.A.
Provider Business Mailing Address
First Line : RR 3 BOX 163-4
Second Line :
City : CLEVELAND
State : OK
Zip : 74020-9514
Country : US
Telephone Number : 918-243-5180
Fax Number :
Provider Business Practice Location Address
First Line : 1401 W PAWNEE ST
Second Line :
City : CLEVELAND
State : OK
Zip : 74020-3033
Country : US
Telephone Number : 918-358-2501
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2006
Last Update Date : 07/09/2007

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