Provider Demographics
NPI:1316040694
Name:WARD, MARK V (PA-C)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:V
Last Name:WARD
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:6827 1ST AVE S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-1242
Mailing Address - Country:US
Mailing Address - Phone:727-767-0575
Mailing Address - Fax:727-333-6020
Practice Address - Street 1:16370 WALSINGHAM ROAD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-3532
Practice Address - Country:US
Practice Address - Phone:727-593-9848
Practice Address - Fax:727-596-4532
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2017-02-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9108536363A00000X
TXPA02140363AM0700X
NC0010-01089363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015407200Medicaid