Provider Demographics
NPI:1992992465
Name:DR DAVID L WARREN MD PC
Entity type:Organization
Organization Name:DR DAVID L WARREN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-631-3534
Mailing Address - Street 1:6801 AIRPORT BLVD
Mailing Address - Street 2:WCC/HBO DEPT
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-3709
Mailing Address - Country:US
Mailing Address - Phone:251-631-3534
Mailing Address - Fax:251-631-3531
Practice Address - Street 1:6801 AIRPORT BLVD
Practice Address - Street 2:WCC/HBO DEPT
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3709
Practice Address - Country:US
Practice Address - Phone:251-631-3534
Practice Address - Fax:251-631-3531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5702208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL528701300Medicaid
ALC71096Medicare UPIN
510G020001Medicare PIN