Provider Demographics
NPI:1497830160
Name:FLAD, WARD B (MD)
Entity Type:Individual
Prefix:
First Name:WARD
Middle Name:B
Last Name:FLAD
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 1:389 RICHARDSON WAY
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-4053
Mailing Address - Country:US
Mailing Address - Phone:415-381-5575
Mailing Address - Fax:
Practice Address - Street 1:389 RICHARDSON WAY
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-4053
Practice Address - Country:US
Practice Address - Phone:415-381-5575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG41285207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G412850Medicaid
00G412850Medicare ID - Type Unspecified
F14470Medicare UPIN