Provider Demographics
NPI:1932400066
Name:WARD, RICHARD DUSTIN (NREMT-P)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:DUSTIN
Last Name:WARD
Suffix:
Gender:M
Credentials:NREMT-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 E OLD BAINBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:JAKIN
Mailing Address - State:GA
Mailing Address - Zip Code:39861-6831
Mailing Address - Country:US
Mailing Address - Phone:229-793-2880
Mailing Address - Fax:
Practice Address - Street 1:453 S NOVASEL ST
Practice Address - Street 2:
Practice Address - City:FORT RUCKER
Practice Address - State:AL
Practice Address - Zip Code:36362-5109
Practice Address - Country:US
Practice Address - Phone:229-793-2880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-05
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0700723146L00000X
GA9096146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic