Healthcare Provider Details

I. General information

NPI: 1245664382
Provider Name (Legal Business Name): GLEN C WARREN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 01/04/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 RIVER OAKS DR SUITE 307
FLOWOOD MS
39232-9530
US

IV. Provider business mailing address

1040 RIVER OAKS DR SUITE 307
FLOWOOD MS
39232-9530
US

V. Phone/Fax

Practice location:
  • Phone: 601-259-9062
  • Fax:
Mailing address:
  • Phone: 601-259-9062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number04577
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: