Provider Demographics
NPI:1912216201
Name:WARD, AARON LEE VESTER IV (IDC)
Entity Type:Individual
Prefix:MR
First Name:AARON
Middle Name:LEE VESTER
Last Name:WARD
Suffix:IV
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3711 PAINTED TRACKS
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:TX
Mailing Address - Zip Code:78125
Mailing Address - Country:US
Mailing Address - Phone:302-723-2537
Mailing Address - Fax:
Practice Address - Street 1:2D RECON BN BLDG A-71
Practice Address - Street 2:
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28542-0138
Practice Address - Country:US
Practice Address - Phone:910-440-7703
Practice Address - Fax:910-440-7397
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
04078636AWOtherJOINT SPECIAL OOPERATIONS SOCOM ADVANCED TACTICAL PRACTITIONER