Provider Demographics
NPI:1356350987
Name:WARD, DALLAS (CNIM)
Entity type:Individual
Prefix:DR
First Name:DALLAS
Middle Name:
Last Name:WARD
Suffix:
Gender:M
Credentials:CNIM
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 591
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-0591
Mailing Address - Country:US
Mailing Address - Phone:385-245-3580
Mailing Address - Fax:
Practice Address - Street 1:285 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-6044
Practice Address - Country:US
Practice Address - Phone:385-245-3580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2866246ZE0600X
2866246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDC4033OtherBLUE CROSS
ID000010148724OtherBLUE SHEILD
IDV02416Medicare UPIN
ID1378630Medicare ID - Type Unspecified