Healthcare Provider Details

I. General information

NPI: 1407885353
Provider Name (Legal Business Name): LAWRENCE WARREN, D.P.M.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 02/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3109 6TH AVE
FORT WORTH TX
76110-3800
US

IV. Provider business mailing address

3109 6TH AVE
FORT WORTH TX
76110-3800
US

V. Phone/Fax

Practice location:
  • Phone: 817-921-5339
  • Fax:
Mailing address:
  • Phone: 817-921-5339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0465
License Number StateTX

VIII. Authorized Official

Name: LAWRENCE WARREN
Title or Position: OWNER
Credential: D.P.M.
Phone: 817-921-5339