Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0216X | Pediatric Rheumatologist | 34010 | SC |
N | 2080P0216X | Pediatric Rheumatologist | H5647 | TX |
NPI | 1497835748 |
---|---|
Provider Name | Robert Warren |
First Address | Charlotte, NC 28275-1461 |
Second Address | Charleston, SC 29425-0100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 27/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
134843501 | (05) | TX |
C87014 | (02) |