=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164635272
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MILO NELSON WARNER D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2007
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 214 CARTER ST
-----------------------------------------------------
City | BERRYVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72616-4303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-423-3355
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 365 COUNTY ROAD 301
-----------------------------------------------------
City | EUREKA SPRINGS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72632-9196
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-253-2729
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | R-4534
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------