Healthcare Provider Details

I. General information

NPI: 1881648293
Provider Name (Legal Business Name): WARREN TRACY HANKINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 INJO DR
LAKE HAVASU CITY AZ
86403-5707
US

IV. Provider business mailing address

2010 INJO DR
LAKE HAVASU CITY AZ
86403-5707
US

V. Phone/Fax

Practice location:
  • Phone: 928-854-5400
  • Fax: 928-854-5401
Mailing address:
  • Phone: 928-854-5400
  • Fax: 928-854-5401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number27481
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: