Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | O11080 | MO |
NPI | 1558415075 |
---|---|
Provider Name | Dr. Roberet L Ward |
First Address | Cape Giraedeau, MO 63701 |
Second Address | Cape Giraedeau, MO 63701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 08/07/2007 |