MEDICARE: DR. WARREN C GEWANT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	16995	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	203204949	OTHER	AL	FED TAX ID
2	B80738	OTHER	AL	VIVA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	203204949	OTHER	AL	HEALTH CHOICE
5	32020 B80738	OTHER	AL	BLUE CROSS BLUE SHIELD
6	3700153	OTHER	AL	UNITED HEALTH CARE
7	B80738	OTHER	AL	HEALTH SPRINGS

General Provider Information

NPI Number	:	1265526008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WARREN C GEWANT M.D.

Provider Business Mailing Address
First Line	:	PO BOX 241145
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36124-1145
Country	:	US
Telephone Number	:	334-273-4520
Fax Number	:	334-273-4425

Provider Business Practice Location Address
First Line	:	2167 NORMANDIE DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36111-2728
Country	:	US
Telephone Number	:	334-286-3444
Fax Number	:	334-286-3450

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	06/12/2008

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