=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235245028
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WALTER G WARREN DPM, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2006
-----------------------------------------------------
Last Update Date | 06/21/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1239 E 4TH STREET RD
-----------------------------------------------------
City | SEYMOUR
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47274-1839
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-524-3338
-----------------------------------------------------
Fax | 812-524-3337
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 707
-----------------------------------------------------
City | SEYMOUR
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47274-0707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-524-3338
-----------------------------------------------------
Fax | 812-524-3337
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. WALTER G WARREN
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 812-524-3338
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 07000678
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------