Provider Demographics
NPI:1730221524
Name:WARD, EUGENE A (MD)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:A
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 1:3450 E FLETCHER AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613
Mailing Address - Country:US
Mailing Address - Phone:813-972-1654
Mailing Address - Fax:813-972-7176
Practice Address - Street 1:3450 E FLETCHER AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4655
Practice Address - Country:US
Practice Address - Phone:813-972-1654
Practice Address - Fax:813-972-7176
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43547207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0689467Medicaid
FL0689467Medicaid
FL30707Medicare ID - Type Unspecified