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General NPI Number Information
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NPI Number | 1124384243
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Entity Type | Individual
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Provider Name | MARK WARREN PA-C
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Gender | Male
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Dates
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Enumeration Date | 04/03/2012
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Last Update Date | 04/03/2012
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Provider Practice Location Address
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Address Line | 1111 INDUSTRIAL BLVD #2
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City | ABILENE
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State | TX
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Zip | 79602-7929
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Country | US
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Telephone | 325-795-9140
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Fax | 325-795-9150
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Provider Business Mailing Address
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Address Line | PO BOX 7104
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City | ABILENE
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State | TX
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Zip | 79608-7104
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Country | US
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Telephone | 325-795-9140
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Fax | 325-795-9150
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA00105
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License Number State | TX
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