Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 28425 | AL |
NPI | 1003019191 |
---|---|
Provider Name | David Tyler Warren |
First Address | Dothan, AL 36301-3001 |
Second Address | Dothan, AL 36301-3022 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2007 |
Last Update Date | 03/05/2010 |