Provider Demographics
NPI:1932372679
Name:ROBERT B WARD MD PA
Entity Type:Organization
Organization Name:ROBERT B WARD MD PA
Other - Org Name:INDIAN RIVER SURGICAL ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-569-5094
Mailing Address - Street 1:526 BAY DR
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-2107
Mailing Address - Country:US
Mailing Address - Phone:772-569-5094
Mailing Address - Fax:
Practice Address - Street 1:526 BAY DR
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32963-2107
Practice Address - Country:US
Practice Address - Phone:772-569-5094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0026613208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL56241600Medicaid
FL31081ZMedicare PIN
FLD62247Medicare UPIN