Provider Demographics
NPI:1104160092
Name:DENNIS R. WARD, MD PA
Entity type:Organization
Organization Name:DENNIS R. WARD, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-831-4454
Mailing Address - Street 1:201 MAITLAND AVE
Mailing Address - Street 2:SUITE 1017
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4903
Mailing Address - Country:US
Mailing Address - Phone:407-831-4454
Mailing Address - Fax:407-831-4559
Practice Address - Street 1:201 MAITLAND AVE
Practice Address - Street 2:SUITE 1017
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4903
Practice Address - Country:US
Practice Address - Phone:407-831-4454
Practice Address - Fax:407-831-4559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME38085208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME 38085OtherSTATE LICENSE