Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 168632-1205 | UT |
N | 207QA0401X | Family Doctor - Addiction Medicine | 168632-1205 | UT |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 168632-1205 | UT |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 168632-1205 | UT |
NPI | 1366421729 |
---|---|
Provider Name | Dr. Steven Edward Warren |
First Address | N Salt Lake, UT 84054-0552 |
Second Address | Bountiful, UT 84010-6083 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2006 |
Last Update Date | 27/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D24885 | (02) | UT |