MEDICARE: MARK A WARD MD INC

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	207Q00000X	Family Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00259106	OTHER	CA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A836860	OTHER	CA	BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548463359
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK A WARD MD INC

Provider Business Mailing Address
First Line	:	355 LAS VEGAS ST
Second Line	:
City	:	MORRO BAY
State	:	CA
Zip	:	93442-1548
Country	:	US
Telephone Number	:	805-772-7100
Fax Number	:	805-772-7776

Provider Business Practice Location Address
First Line	:	355 LAS VEGAS ST
Second Line	:
City	:	MORRO BAY
State	:	CA
Zip	:	93442-1548
Country	:	US
Telephone Number	:	805-772-7100
Fax Number	:	805-772-7776

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARK ALAN WARD
Credential	:	M.D.
Telephone Number	:	805-772-7100

Provider Enumeration Date	:	06/08/2007
Last Update Date	:	01/29/2014

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