Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 8142 | KY |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 8142 | KY |
N | 204E00000X | Oral & Maxillofacial Surgeon | 44040 | KY |
NPI | 1437291655 |
---|---|
Provider Name | Dr. Jamie Allen Warren |
First Address | Louisville, KY 40205-2164 |
Second Address | Louisville, KY 40205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2007 |
Last Update Date | 07/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201055760 | (05) | IN |
7100152170 | (05) | KY |
7100154720 | (05) | KY |
P01500679 | RAILROAD MEDICARE (01) | KY |