Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | DO523 | AL |
N | 207QA0401X | Family Doctor - Addiction Medicine | DO523 | AL |
NPI | 1417064536 |
---|---|
Provider Name | Dr. Diana W. Warren |
First Address | Haleyville, AL 35565-0880 |
Second Address | Haleyville, AL 35565 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 10/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G75727 | (02) | AL |