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General NPI Number Information
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NPI Number | 1407885353
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Entity Type | Organization
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Legal Business Name | LAWRENCE WARREN, D.P.M.,P.C.
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Dates
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Enumeration Date | 07/02/2006
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Last Update Date | 02/16/2010
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Provider Practice Location Address
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Address Line | 3109 6TH AVE
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City | FORT WORTH
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State | TX
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Zip | 76110-3800
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Country | US
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Telephone | 817-921-5339
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Fax |
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Provider Business Mailing Address
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Address Line | 3109 6TH AVE
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City | FORT WORTH
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State | TX
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Zip | 76110-3800
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Country | US
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Telephone | 817-921-5339
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAWRENCE WARREN
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Credential | D.P.M.
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Telephone | 817-921-5339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 0465
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License Number State | TX
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