Provider Demographics
NPI:1851329122
Name:WARD, PETER ALLAN (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:ALLAN
Last Name:WARD
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 BERGER RD
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-4522
Mailing Address - Country:US
Mailing Address - Phone:270-444-0119
Mailing Address - Fax:270-444-9129
Practice Address - Street 1:242 BERGER RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-4522
Practice Address - Country:US
Practice Address - Phone:270-444-0119
Practice Address - Fax:270-444-9129
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY15202208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64095334Medicaid
C74949Medicare UPIN
KY0944301Medicare PIN