Provider Demographics
NPI:1699066019
Name:WARD, REGINALD ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:REGINALD
Middle Name:ANTHONY
Last Name:WARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 E PINE ST
Mailing Address - Street 2:APT 1124
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-2838
Mailing Address - Country:US
Mailing Address - Phone:813-391-5302
Mailing Address - Fax:
Practice Address - Street 1:45 W 10TH STREET
Practice Address - Street 2:
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-1062
Practice Address - Country:US
Practice Address - Phone:651-232-3000
Practice Address - Fax:651-232-1187
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI82996207P00000X
KY56980207P00000X
TXR0807207P00000X
FLME119503207P00000X
MN61873207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine