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NPI Code Detail

MEDICARE: DR. PAUL D. WARDLAW MD

MEDICARE: DR. PAUL D. WARDLAW MD
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
1207Q00000XFamily Medicine PhysicianDR.0055619CO
2207Q00000XFamily Medicine Physician04-21220KS

General Provider Information

NPI Number : 1821064114
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PAUL D. WARDLAW MD
Provider Business Mailing Address
First Line : 1337 S. FOUNTAIN DRIVE
Second Line :
City : OLATHE
State : KS
Zip : 66061
Country : US
Telephone Number : 785-483-3131
Fax Number : 785-483-4859
Provider Business Practice Location Address
First Line : 200 S MAIN ST
Second Line :
City : RUSSELL
State : KS
Zip : 67665-2920
Country : US
Telephone Number : 785-483-3131
Fax Number : 785-483-4859
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2006
Last Update Date : 09/26/2017

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