Provider Demographics
NPI:1790878601
Name:WARDLE, DAVID LJ (MD FRCS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LJ
Last Name:WARDLE
Suffix:
Gender:M
Credentials:MD FRCS
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Mailing Address - Street 1:360 SAN MIGUEL DR STE 406
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7822
Mailing Address - Country:US
Mailing Address - Phone:949-719-2826
Mailing Address - Fax:949-759-5458
Practice Address - Street 1:360 SAN MIGUEL DR STE 406
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7822
Practice Address - Country:US
Practice Address - Phone:949-719-2826
Practice Address - Fax:949-759-5458
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA51102208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF85200Medicare UPIN