Healthcare Provider Details

I. General information

NPI: 1174755854
Provider Name (Legal Business Name): WARREN WILSON MEBANE JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2009
Last Update Date: 06/10/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 MEDICAL CENTER ROAD
FORT CAVAZOS TX
76544-5060
US

IV. Provider business mailing address

590 MEDICAL CENTER DRIVE
FORT CAVAZOS TX
76544-5060
US

V. Phone/Fax

Practice location:
  • Phone: 254-553-8670
  • Fax: 254-618-1016
Mailing address:
  • Phone: 254-553-8670
  • Fax: 254-618-1016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD421774
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: