Healthcare Provider Details

I. General information

NPI: 1376674408
Provider Name (Legal Business Name): BARTON L. WARREN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 W WASHINGTON AVE
RICHLAND MO
65556-7101
US

IV. Provider business mailing address

304 W WASHINGTON AVE P.O. BOX 777
RICHLAND MO
65556-7101
US

V. Phone/Fax

Practice location:
  • Phone: 573-765-5131
  • Fax: 573-765-3122
Mailing address:
  • Phone: 573-765-5131
  • Fax: 573-765-3122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMDR9E91
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMDR9E91
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: