Provider Demographics
NPI:1043306061
Name:WARD, ANNE MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:WARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:MARIE
Other - Last Name:SAMMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1411 N. BECKLEY AVE.
Mailing Address - Street 2:PAVILION III SUITE 268
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203
Mailing Address - Country:US
Mailing Address - Phone:214-947-4400
Mailing Address - Fax:214-947-4404
Practice Address - Street 1:1411 N. BECKLEY AVE.
Practice Address - Street 2:PAVILION III SUITE 268
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203
Practice Address - Country:US
Practice Address - Phone:214-947-4400
Practice Address - Fax:214-947-4404
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085001433363A00000X
TXPA11889363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK17674Medicare ID - Type Unspecified
ILP15233Medicare UPIN