Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 20878 | TX |
N | 204E00000X | Oral & Maxillofacial Surgeon | M9730 | TX |
NPI | 1386822237 |
---|---|
Provider Name | Dr. Russell Scott Warren |
First Address | Woodway, TX 76712-3100 |
Second Address | Woodway, TX 76712-3100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2008 |
Last Update Date | 30/09/2008 |