Healthcare Provider Details

I. General information

NPI: 1528083078
Provider Name (Legal Business Name): RODERICK WARREN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 RAVENHILL DR STE 100&107
ATCHISON KS
66002-9204
US

IV. Provider business mailing address

800 RAVENHILL DR
ATCHISON KS
66002-9204
US

V. Phone/Fax

Practice location:
  • Phone: 913-674-2340
  • Fax: 913-674-2039
Mailing address:
  • Phone: 913-367-2131
  • Fax: 913-674-2023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0428647
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number22487
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: