Provider Demographics
NPI:1043528664
Name:WARE, JOE ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:JOE
Middle Name:ANTHONY
Last Name:WARE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:J
Other - Middle Name:ANTHONY
Other - Last Name:WARE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:430 N PARK AVE
Mailing Address - Street 2:#601
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-3676
Mailing Address - Country:US
Mailing Address - Phone:317-658-5021
Mailing Address - Fax:
Practice Address - Street 1:430 N PARK AVE
Practice Address - Street 2:#601
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-3676
Practice Address - Country:US
Practice Address - Phone:317-658-5021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01054920A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN6176607Medicaid