Provider Demographics
NPI:1649587403
Name:WARD, JOHN GRANVILLE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GRANVILLE
Last Name:WARD
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 1:1634 MURPHY PKWY
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-1753
Mailing Address - Country:US
Mailing Address - Phone:651-688-0451
Mailing Address - Fax:
Practice Address - Street 1:1634 MURPHY PKWY
Practice Address - Street 2:HOME ADDRESS NO BUSINESS ADDRESS
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-1753
Practice Address - Country:US
Practice Address - Phone:651-688-0451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN25388207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine