Provider Demographics
NPI:1457701864
Name:WARD, MATTHEW AARON (DO)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:AARON
Last Name:WARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2514 67TH AVENUE LOOP
Mailing Address - Street 2:SUITE 112
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39307-7259
Mailing Address - Country:US
Mailing Address - Phone:601-482-4955
Mailing Address - Fax:
Practice Address - Street 1:2514 67TH AVENUE LOOP
Practice Address - Street 2:SUITE 112
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39307-7259
Practice Address - Country:US
Practice Address - Phone:601-482-4955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-3254390200000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program