Provider Demographics
NPI:1154589133
Name:WILLIAM J. WARREN DPM PA
Entity type:Organization
Organization Name:WILLIAM J. WARREN DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:940-325-3330
Mailing Address - Street 1:218 SW 26TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MINERAL WELLS
Mailing Address - State:TX
Mailing Address - Zip Code:76067-8248
Mailing Address - Country:US
Mailing Address - Phone:940-325-3330
Mailing Address - Fax:940-325-3338
Practice Address - Street 1:218 SW 26TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MINERAL WELLS
Practice Address - State:TX
Practice Address - Zip Code:76067-8248
Practice Address - Country:US
Practice Address - Phone:940-325-3330
Practice Address - Fax:940-325-3338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1689213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXVO2889Medicare UPIN