Provider Demographics
NPI:1740289644
Name:WARD, MATTHEW J (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:J
Last Name:WARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22241 WOOD RUN CT
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:34135-7247
Mailing Address - Country:US
Mailing Address - Phone:239-498-3334
Mailing Address - Fax:
Practice Address - Street 1:22241 WOOD RUN CT
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:34135-7247
Practice Address - Country:US
Practice Address - Phone:239-498-3334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME998372085R0202X
WV164972085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL07629OtherBCBS OF FL
FL280115900Medicaid
FLME99837OtherFL LICENSE
WV0119374000Medicaid
F13495Medicare UPIN
FL07629OtherBCBS OF FL
WA0705608Medicare ID - Type Unspecified
P00457620Medicare PIN