Provider Demographics
NPI:1114378023
Name:WARD MD LLC
Entity Type:Organization
Organization Name:WARD MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:PRESTON
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-739-3395
Mailing Address - Street 1:3204 E DEER RIDGE PL
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-6553
Mailing Address - Country:US
Mailing Address - Phone:801-739-3395
Mailing Address - Fax:
Practice Address - Street 1:6322 S 3000 E
Practice Address - Street 2:SUITE 170
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-6922
Practice Address - Country:US
Practice Address - Phone:801-739-3395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT327556-1205207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty