Provider Demographics
NPI:1194754788
Name:WARNER, GORDON SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:GORDON
Middle Name:SCOTT
Last Name:WARNER
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 1:1803 PARK VIEW DRIVE, NE
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35058-3618
Mailing Address - Country:US
Mailing Address - Phone:256-739-7050
Mailing Address - Fax:256-739-7052
Practice Address - Street 1:1803 PARK VIEW DRIVE, NE
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-3618
Practice Address - Country:US
Practice Address - Phone:256-739-7050
Practice Address - Fax:256-739-7052
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
AL15910207PE0004X, 207RC0200X, 207RH0002X, 207RP1001X, 2080S0012X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No2080S0012XAllopathic & Osteopathic PhysiciansPediatricsSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL26374Medicaid
AL26374Medicaid
ALE90911Medicare UPIN