Healthcare Provider Details

I. General information

NPI: 1841519394
Provider Name (Legal Business Name): MARGARET ANNE WARREN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAGGIE WARREN D.O

II. Dates (important events)

Enumeration Date: 05/24/2010
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 S FLEISHEL AVE
TYLER TX
75701-2041
US

IV. Provider business mailing address

620 S FLEISHEL AVE
TYLER TX
75701-2041
US

V. Phone/Fax

Practice location:
  • Phone: 903-606-4900
  • Fax:
Mailing address:
  • Phone: 903-606-4900
  • Fax: 903-606-4699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberR5679
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberOS017025
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberR5679
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: