Provider Demographics
NPI:1528336294
Name:WARD, GARY LUTHER II (DO)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:LUTHER
Last Name:WARD
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3100 OAK GROVE RD
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-3396
Mailing Address - Country:US
Mailing Address - Phone:573-776-2000
Mailing Address - Fax:
Practice Address - Street 1:2002 KANELL BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-4045
Practice Address - Country:US
Practice Address - Phone:573-712-2546
Practice Address - Fax:573-712-2549
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2013-02-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2012009853207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine