Provider Demographics
NPI:1679502017
Name:WARD, DAVID M (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
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:PO BOX 3360
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3360
Mailing Address - Country:US
Mailing Address - Phone:866-747-2455
Mailing Address - Fax:
Practice Address - Street 1:149 LILLY RD NE
Practice Address - Street 2:PMG SW WA OLYMPIA UROLOGY
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5028
Practice Address - Country:US
Practice Address - Phone:360-486-6772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00033608208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA340013770OtherRAILROAD MEDICARE
WA107973OtherLABOR AND INDUSTRY
WA8192460Medicaid
WAG27063Medicare UPIN
WA001048508Medicare ID - Type Unspecified
WAWA9810OtherREGENCE