Provider Demographics
NPI:1841218690
Name:WARD, RICHARD EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:EDWARD
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 1:3941 J ST 362
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3633
Mailing Address - Country:US
Mailing Address - Phone:916-733-0660
Mailing Address - Fax:916-733-0664
Practice Address - Street 1:3941 J ST 362
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3633
Practice Address - Country:US
Practice Address - Phone:916-733-0660
Practice Address - Fax:916-733-0664
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC0368822086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
330001490OtherRAILROAD MEDICARE
CAGR0049280Medicaid
11469632OtherCAQH
CAGR0049280Medicaid
CAAY249ZMedicare PIN