Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 200000659 | NC |
NPI | 1386715639 |
---|---|
Provider Name | Dr. Thomas B Warren |
First Address | Mooresville, NC 28117-7561 |
Second Address | Mooresville, NC 28117-8522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2006 |
Last Update Date | 26/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
130KY | BCBS (01) | NC |
89130KY | (05) | NC |
G93344 | (02) | NC |