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General NPI Number Information
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NPI Number | 1750382339
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Entity Type | Individual
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Provider Name | WARREN C BOTNICK M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 07/15/2020
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Provider Practice Location Address
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Address Line | 601 KEYSER AVE
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City | NATCHITOCHES
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State | LA
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Zip | 71457-6020
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Country | US
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Telephone | 318-214-5770
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2475
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City | NATCHITOCHES
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State | LA
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Zip | 71457-2475
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Country | US
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Telephone | 318-214-5770
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Fax |
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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 | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | MD.207802
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number | MD.207802
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | MD.207802
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License Number State | LA
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