MEDICARE: EVAN WARD PA-C

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	363A00000X	Physician Assistant	PA09131	TX

General Provider Information

NPI Number	:	1841616679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVAN WARD PA-C

Provider Business Mailing Address
First Line	:	1045 GEMINI ST STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-2806
Country	:	US
Telephone Number	:	281-335-1111
Fax Number	:	281-286-9250

Provider Business Practice Location Address
First Line	:	1045 GEMINI ST STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-2806
Country	:	US
Telephone Number	:	281-335-1111
Fax Number	:	281-286-9250

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

Provider Enumeration Date	:	03/18/2014
Last Update Date	:	09/15/2022

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Directions to “ EVAN WARD PA-C” Practice Location

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