Provider Demographics
NPI:1659782514
Name:WARD, ERIC T (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:T
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:DEPARTMENT OF PSYCHIATRY
Mailing Address - Street 2:2001 JUNIPERO SERRA BLVD
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94014-3891
Mailing Address - Country:US
Mailing Address - Phone:650-742-2000
Mailing Address - Fax:877-738-4262
Practice Address - Street 1:DEPARTMENT OF PSYCHIATRY
Practice Address - Street 2:2001 JUNIPERO SERRA BLVD
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:27599-0001
Practice Address - Country:US
Practice Address - Phone:650-742-2000
Practice Address - Fax:877-738-4262
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA1532812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program