Provider Demographics
NPI:1134114473
Name:WARD, NATHAN C (MD)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:C
Last Name:WARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:620 MEDICAL DR
Mailing Address - Street 2:SUITE 340
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-4908
Mailing Address - Country:US
Mailing Address - Phone:801-299-2229
Mailing Address - Fax:801-299-2230
Practice Address - Street 1:620 MEDICAL DR
Practice Address - Street 2:SUITE 340
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-4908
Practice Address - Country:US
Practice Address - Phone:801-299-2229
Practice Address - Fax:801-299-2230
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5618401-1205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00247983Medicare PIN
UTF70486Medicare UPIN