Healthcare Provider Details

I. General information

NPI: 1750390142
Provider Name (Legal Business Name): WARREN JOHNSON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 05/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6305 ELYSIAN FIELDS AVE 204
NEW ORLEANS LA
70122-4245
US

IV. Provider business mailing address

6305 ELYSIAN FIELDS AVE 204
NEW ORLEANS LA
70122-4245
US

V. Phone/Fax

Practice location:
  • Phone: 504-286-0202
  • Fax: 504-286-0702
Mailing address:
  • Phone: 504-286-0202
  • Fax: 504-286-0702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPD144R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: