Provider Demographics
NPI:1396749198
Name:WARD, PHILLIP EVANS (DPM)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:EVANS
Last Name:WARD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 40908
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28309-0908
Mailing Address - Country:US
Mailing Address - Phone:910-615-6949
Mailing Address - Fax:910-615-9761
Practice Address - Street 1:815 WESLEY PINES RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2359
Practice Address - Country:US
Practice Address - Phone:910-737-6600
Practice Address - Fax:910-737-6532
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC292213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890819AMedicaid
SCPC0968Medicaid
SCT83477Medicare UPIN
NC890819AMedicaid
SCPC0968Medicaid