Healthcare Provider Details

I. General information

NPI: 1104116821
Provider Name (Legal Business Name): STEPHEN WARNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2011
Last Update Date: 12/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6414 FANNIN ST SUITE G-150
HOUSTON TX
77030-1517
US

IV. Provider business mailing address

6414 FANNIN ST SUITE G-150
HOUSTON TX
77030-1517
US

V. Phone/Fax

Practice location:
  • Phone: 713-512-7240
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberR3245
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: