Provider Demographics
NPI:1548463359
Name:MARK A WARD MD INC
Entity type:Organization
Organization Name:MARK A WARD MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-772-7100
Mailing Address - Street 1:355 LAS VEGAS ST
Mailing Address - Street 2:
Mailing Address - City:MORRO BAY
Mailing Address - State:CA
Mailing Address - Zip Code:93442-1548
Mailing Address - Country:US
Mailing Address - Phone:805-772-7100
Mailing Address - Fax:805-772-7776
Practice Address - Street 1:355 LAS VEGAS ST
Practice Address - Street 2:
Practice Address - City:MORRO BAY
Practice Address - State:CA
Practice Address - Zip Code:93442-1548
Practice Address - Country:US
Practice Address - Phone:805-772-7100
Practice Address - Fax:805-772-7776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A836860OtherBLUE SHIELD
CAP00259106OtherRAILROAD MEDICARE
CA00A836860Medicaid
CAH95760Medicare UPIN
CAP00259106OtherRAILROAD MEDICARE