Provider Demographics
NPI:1497782700
Name:WARD, DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:WARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 VILLAGE SQUARE XING STE 290
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4552
Mailing Address - Country:US
Mailing Address - Phone:239-313-2517
Mailing Address - Fax:239-666-9211
Practice Address - Street 1:9125 CORSEA DEL FONTANA WAY STE 100
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-4430
Practice Address - Country:US
Practice Address - Phone:239-598-4004
Practice Address - Fax:239-598-4713
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME151732207N00000X, 2086S0129X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036100234-2Medicaid
IL05721369OtherBC/BS
ILG74903Medicare UPIN
IL036100234-2Medicaid