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General NPI Number Information
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NPI Number | 1790779254
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Entity Type | Individual
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Provider Name | BRENT BLAIR WARREN MD
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Gender | Male
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Dates
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Enumeration Date | 09/09/2005
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Last Update Date | 04/26/2021
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Provider Practice Location Address
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Address Line | 646 HARTNESS RD
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City | STATESVILLE
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State | NC
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Zip | 28677-3423
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Country | US
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Telephone | 704-872-4108
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Fax | 704-873-6517
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Provider Business Mailing Address
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Address Line | 6035 FAIRVIEW RD
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City | CHARLOTTE
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State | NC
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Zip | 28210-3256
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Country | US
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Telephone | 704-295-3000
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Fax | 704-838-8494
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 200301426
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License Number State | NC
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