Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 0101058667 | VA |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 0101058667 | VA |
NPI | 1205814068 |
---|---|
Provider Name | Paul Douglas Warren |
First Address | Virginia Beach, VA 23462-1832 |
Second Address | Virginia Beach, VA 23456-0167 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2006 |
Last Update Date | 17/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006401490 | (05) | VA |
200040146 | RAILROAD MEDICARE (01) | |
C05501 | MEDICARE GROUP (01) | VA |
CC7688 | RAILROAD MEDICARE GROUP# (01) |