Provider Demographics
NPI:1639244825
Name:WARD, KENT W (DO)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:W
Last Name:WARD
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1680 IRON SPRINGS RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305
Mailing Address - Country:US
Mailing Address - Phone:928-778-1280
Mailing Address - Fax:928-778-2665
Practice Address - Street 1:1680 IRON SPRINGS RD
Practice Address - Street 2:SUITE 104
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305
Practice Address - Country:US
Practice Address - Phone:928-778-1280
Practice Address - Fax:928-778-2665
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2012-02-01
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Provider Licenses
StateLicense IDTaxonomies
AZ1426204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
47188Medicare UPIN