1184687253 NPI number — BRYAN CLARK MORRIS WARD M.D.

Table of content: BRYAN CLARK MORRIS WARD M.D. (NPI 1184687253)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184687253 NPI number — BRYAN CLARK MORRIS WARD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORRIS WARD
Provider First Name:
BRYAN
Provider Middle Name:
CLARK
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184687253
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4545 POINT FOSDICK DR NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GIG HARBOR
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98335-1700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-538-8000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 LILLY RD NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLYMPIA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98506-5115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-923-7000
Provider Business Practice Location Address Fax Number:
360-923-7089
Provider Enumeration Date:
04/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD00028839 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0156133 . This is a "LABOR AND INDUSTRY INSURA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 080182243 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1112853 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8811MO . This is a "REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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