Basic Information
| Provider Information | |||||||||
| NPI: | 1699066019 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WARD | ||||||||
| FirstName: | REGINALD | ||||||||
| MiddleName: | ANTHONY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 415 E PINE ST | ||||||||
| Address2: | APT 1124 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328012838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8133915302 | ||||||||
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| Practice Location | |||||||||
| Address1: | 45 W 10TH STREET | ||||||||
| Address2: | |||||||||
| City: | ST PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551021062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512323000 | ||||||||
| FaxNumber: | 6512321187 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2011 | ||||||||
| LastUpdateDate: | 09/19/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | R0807 | TX | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | ME119503 | FL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 61873 | MN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 56980 | KY | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.