Provider Demographics
NPI:1508894262
Name:WARD, ROBERT M JR (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:WARD
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 587
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83303-0587
Mailing Address - Country:US
Mailing Address - Phone:208-814-7400
Mailing Address - Fax:208-814-7491
Practice Address - Street 1:775 POLE LINE RD W
Practice Address - Street 2:SUITE 203
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5814
Practice Address - Country:US
Practice Address - Phone:208-814-8300
Practice Address - Fax:208-733-8970
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM6665207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDP00721167OtherMCRR
ID004292000Medicaid
IDP00721167OtherMCRR
IDG05133Medicare UPIN