Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | MD09061 | OR |
NPI | 1033194873 |
---|---|
Provider Name | Dr. Gary Allen Ward |
First Address | Portland, OR 97210-3057 |
Second Address | Portland, OR 97210-3057 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
270306 | (05) | OR |
E33777 | (02) |