Provider Demographics
NPI:1619961125
Name:WARD, DENNIS ROY (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:ROY
Last Name:WARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:201 MAITLAND AVE
Mailing Address - Street 2:SUITE 1017
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4903
Mailing Address - Country:US
Mailing Address - Phone:407-831-4454
Mailing Address - Fax:407-831-4559
Practice Address - Street 1:201 MAITLAND AVE
Practice Address - Street 2:SUITE 1017
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4903
Practice Address - Country:US
Practice Address - Phone:407-831-4454
Practice Address - Fax:407-831-4559
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME38085208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE11975Medicare UPIN
FL59915Medicare ID - Type Unspecified