Provider Demographics
NPI:1821064114
Name:WARDLAW, PAUL D (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:D
Last Name:WARDLAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1337 S. FOUNTAIN DRIVE
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061
Mailing Address - Country:US
Mailing Address - Phone:785-483-3131
Mailing Address - Fax:785-483-4859
Practice Address - Street 1:200 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RUSSELL
Practice Address - State:KS
Practice Address - Zip Code:67665-2920
Practice Address - Country:US
Practice Address - Phone:785-483-3131
Practice Address - Fax:785-483-4859
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CODR.0055619207Q00000X
KS04-21220207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSG80201Medicare UPIN
Q26D341Medicare ID - Type Unspecified