Provider Demographics
NPI:1508859679
Name:WARD, JEFFREY S (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:S
Last Name:WARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1720 COOPER FOSTER PARK RD W
Mailing Address - Street 2:SUITE B
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-4200
Mailing Address - Country:US
Mailing Address - Phone:440-989-4480
Mailing Address - Fax:440-989-4484
Practice Address - Street 1:1720 COOPER FOSTER PARK RD W
Practice Address - Street 2:SUITE B
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-4200
Practice Address - Country:US
Practice Address - Phone:440-989-4480
Practice Address - Fax:440-989-4484
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-6273-W2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2026042Medicaid
OH2026042Medicaid