Healthcare Provider Details

I. General information

NPI: 1801870936
Provider Name (Legal Business Name): DIRK A WARREN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 477 BOX 2
FPO AP NAF ATSUGI
96306
JP

IV. Provider business mailing address

PSC 477 BOX 2
FPO AP NAF ATSUGI
96306
JP

V. Phone/Fax

Practice location:
  • Phone: 01181467634692
  • Fax:
Mailing address:
  • Phone: 01181467634692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License NumberD0060723
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: