Healthcare Provider Details

I. General information

NPI: 1528026523
Provider Name (Legal Business Name): ROBERT S WARNER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 01/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 HIGH ST STE 102
LEWISTON ME
04240-7676
US

IV. Provider business mailing address

12 HIGH ST STE 102
LEWISTON ME
04240-7676
US

V. Phone/Fax

Practice location:
  • Phone: 207-784-4539
  • Fax: 207-784-2868
Mailing address:
  • Phone: 207-784-4539
  • Fax: 207-784-2868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number1020
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: