Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 508 | ID |
N | 207R00000X | Internist | 508C | ID |
N | 111NI0900X | Internist | 508C | ID |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 508C | ID |
N | 175F00000X | Naturopath | 508 | ID |
NPI | 1033287040 |
---|---|
Provider Name | Dr. Robert E Ward III |
First Address | Pocatello, ID 83206-3052 |
Second Address | Pocatello, ID 83201-4621 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 01/03/2016 |