Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | G3896 | TX |
NPI | 1194780379 |
---|---|
Provider Name | Harry Lee Warren JR. |
First Address | Fort Bragg, NC 28310 |
Second Address | Fort Bragg, NC 28310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2006 |
Last Update Date | 08/07/2007 |