MEDICARE: LAWRENCE WARREN, D.P.M.,P.C.

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	213E00000X	Podiatrist	0465	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	00Z585	OTHER	TX	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0070PW	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1407885353
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAWRENCE WARREN, D.P.M.,P.C.

Provider Business Mailing Address
First Line	:	3109 6TH AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-3800
Country	:	US
Telephone Number	:	817-921-5339
Fax Number	:

Provider Business Practice Location Address
First Line	:	3109 6TH AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-3800
Country	:	US
Telephone Number	:	817-921-5339
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LAWRENCE WARREN
Credential	:	D.P.M.
Telephone Number	:	817-921-5339

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	02/16/2010

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