Provider Demographics
NPI:1821092339
Name:WARD, KEVIN JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:JOSEPH
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 1:34612 6TH AVE S
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8723
Mailing Address - Country:US
Mailing Address - Phone:253-927-1882
Mailing Address - Fax:253-927-1439
Practice Address - Street 1:34612 6TH AVE S
Practice Address - Street 2:SUITE 210
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8723
Practice Address - Country:US
Practice Address - Phone:253-927-1882
Practice Address - Fax:253-927-1439
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00027535208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7125081Medicaid
WA1427128198OtherGROUP NPI
E72333Medicare UPIN
WA7125081Medicaid
WAGAB12536Medicare PIN