Provider Demographics
NPI:1235217506
Name:WARD, REED IVOL (DO)
Entity Type:Individual
Prefix:
First Name:REED
Middle Name:IVOL
Last Name:WARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3425 POTOMAC WAY
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-4970
Mailing Address - Country:US
Mailing Address - Phone:208-528-8170
Mailing Address - Fax:208-552-5461
Practice Address - Street 1:3425 POTOMAC WAY
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-4970
Practice Address - Country:US
Practice Address - Phone:208-528-8170
Practice Address - Fax:208-552-5461
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ID0263207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010138476OtherBS
IDS3812OtherBC
ID806385700Medicaid
ID806385700Medicaid