Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 05169 | MS |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 05169 | MS |
NPI | 1174742688 |
---|---|
Provider Name | Dr. E Frazier Ward |
First Address | Jackson, MS 39216 |
Second Address | Jackson, MS 39216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 14/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00013744 | (05) | MS |
0013744 | (05) | MS |
207X00000X | TAXONOMY (01) | MS |
51220014 | MCR PTAN (01) | |
B1132 | (02) | MS |
B31132 | (02) |