Provider Demographics
NPI:1215126974
Name:BRYAN MORRIS-WARD MD PLLC
Entity type:Organization
Organization Name:BRYAN MORRIS-WARD MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MORRIS-WARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-486-0617
Mailing Address - Street 1:1401 MARVIN RD NE
Mailing Address - Street 2:#307 PMB 266
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-5749
Mailing Address - Country:US
Mailing Address - Phone:360-491-5055
Mailing Address - Fax:360-491-5890
Practice Address - Street 1:520 LILLY RD NE BLDG 3
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5102
Practice Address - Country:US
Practice Address - Phone:360-486-0617
Practice Address - Fax:360-486-0621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00028839207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1112853Medicaid
WAF06584Medicare UPIN
WAGAB33241Medicare PIN