Provider Demographics
NPI:1477021517
Name:WARD, BRUCE ARNOLD (PA-C)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:ARNOLD
Last Name:WARD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:350 PINE STATE ST
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-9428
Mailing Address - Country:US
Mailing Address - Phone:910-893-9700
Mailing Address - Fax:910-814-9055
Practice Address - Street 1:104 TILGHMAN DR
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-5533
Practice Address - Country:US
Practice Address - Phone:910-892-1333
Practice Address - Fax:910-892-2757
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-07
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-08591363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty