Healthcare Provider Details

I. General information

NPI: 1245566025
Provider Name (Legal Business Name): MICHAEL W WARNER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2009
Last Update Date: 12/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10290 US HIGHWAY 87 E
ADKINS TX
78101-1906
US

IV. Provider business mailing address

10290 US HIGHWAY 87 E
ADKINS TX
78101-1906
US

V. Phone/Fax

Practice location:
  • Phone: 210-789-7455
  • Fax:
Mailing address:
  • Phone: 210-789-7455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA01367
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: