Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | K1126 | TX |
NPI | 1033159215 |
---|---|
Provider Name | Gregory Alan Ward |
First Address | Fort Worth, TX 76104-3903 |
Second Address | Fort Worth, TX 76104-3903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 27/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
125820401 | (05) | TX |