Provider Demographics
NPI:1588744346
Name:WARD, GREGORY L (DO)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:L
Last Name:WARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 S L ROGERS WELLS BLVD
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-1191
Mailing Address - Country:US
Mailing Address - Phone:270-651-7796
Mailing Address - Fax:270-651-7074
Practice Address - Street 1:411 S L ROGERS WELLS BLVD
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-1191
Practice Address - Country:US
Practice Address - Phone:270-651-7796
Practice Address - Fax:270-651-7074
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02763207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64062045Medicaid
KY02763OtherLICENSE
KY02763OtherLICENSE
KYBW7988237OtherDEA
KYH70053Medicare UPIN
KYBW7988237OtherDEA