Healthcare Provider Details

I. General information

NPI: 1265526008
Provider Name (Legal Business Name): WARREN C GEWANT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2167 NORMANDIE DR
MONTGOMERY AL
36111-2728
US

IV. Provider business mailing address

PO BOX 241145
MONTGOMERY AL
36124-1145
US

V. Phone/Fax

Practice location:
  • Phone: 334-286-3444
  • Fax: 334-286-3450
Mailing address:
  • Phone: 334-273-4520
  • Fax: 334-273-4425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number16995
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: