Healthcare Provider Details

I. General information

NPI: 1710044128
Provider Name (Legal Business Name): DONALD K WARNE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

483 W. SEED FARM RD.
SACATON AZ
85247
US

IV. Provider business mailing address

P O BOX 115 GILA RIVER HEALTH CARE CORPORATION - CREDENTIALING
SACATON AZ
85247-0115
US

V. Phone/Fax

Practice location:
  • Phone: 602-528-1340
  • Fax: 602-528-1296
Mailing address:
  • Phone: 602-528-1340
  • Fax: 602-528-1296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number224394
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: