Provider Demographics
NPI:1316923931
Name:WARREN, LARRY E (DO)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:E
Last Name:WARREN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 KATE IRELAND DR
Mailing Address - Street 2:
Mailing Address - City:HYDEN
Mailing Address - State:KY
Mailing Address - Zip Code:41749-9071
Mailing Address - Country:US
Mailing Address - Phone:606-672-2341
Mailing Address - Fax:606-672-5254
Practice Address - Street 1:130 KATE IRELAND DR
Practice Address - Street 2:
Practice Address - City:HYDEN
Practice Address - State:KY
Practice Address - Zip Code:41749-9071
Practice Address - Country:US
Practice Address - Phone:606-672-2341
Practice Address - Fax:606-672-5254
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02875207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1388019OtherMEDICARE
KY64100514Medicaid
KYC92475OtherCHI
KY000000503474OtherANTHEM BCBS
KY1388019OtherMEDICARE
KY0674008Medicare ID - Type Unspecified