Provider Demographics
NPI:1275590549
Name:WARD, CHRISTOPHER W (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:W
Last Name:WARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1460
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:96020-1460
Mailing Address - Country:US
Mailing Address - Phone:530-258-3329
Mailing Address - Fax:530-258-2004
Practice Address - Street 1:199 REYNOLDS RD
Practice Address - Street 2:130 BRENTWOOD DR
Practice Address - City:CHESTER
Practice Address - State:CA
Practice Address - Zip Code:96020
Practice Address - Country:US
Practice Address - Phone:530-258-3329
Practice Address - Fax:530-258-2004
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68780207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX68780Medicaid
E93601Medicare UPIN
020A68780Medicare ID - Type Unspecified