Healthcare Provider Details

I. General information

NPI: 1598773350
Provider Name (Legal Business Name): ROSS L WARREN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W MAIN ST
COLDWATER OH
45828-1613
US

IV. Provider business mailing address

2900 UPPER BELLBROOK RD
BELLBROOK OH
45305-9720
US

V. Phone/Fax

Practice location:
  • Phone: 419-678-5101
  • Fax:
Mailing address:
  • Phone: 937-429-4576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOH34003941
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: