Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 0S008601L | PA |
Y | 207Q00000X | Family Doctor | 0S008601L | PA |
NPI | 1568450872 |
---|---|
Provider Name | Mr. Michael J Warner |
First Address | Johnstown, PA 15905-4305 |
Second Address | Ebensburg, PA 15931-4107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2005 |
Last Update Date | 14/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F57857 | (02) |