Provider Demographics
NPI:1952466500
Name:WARD, BRIAN PAUL (PAC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:PAUL
Last Name:WARD
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 86459
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85080
Mailing Address - Country:US
Mailing Address - Phone:602-251-8316
Mailing Address - Fax:480-333-5165
Practice Address - Street 1:1800 E VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006
Practice Address - Country:US
Practice Address - Phone:602-251-8316
Practice Address - Fax:480-333-5165
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12265363A00000X
AZ2891363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ139841Medicaid
AZ866684Medicaid
AZ866684Medicaid
AZ82384Medicare PIN