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NPI Code Detail

MEDICARE: DR. SHERISA WARREN D.O.

MEDICARE: DR. SHERISA WARREN D.O.
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
1208600000XSurgery Physician5101018187MI
2208600000XSurgery PhysicianTP417KY
3208600000XSurgery Physician7204OK
42086S0129XVascular Surgery PhysicianTP417KY
52086S0129XVascular Surgery Physician7204OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17204OTHEROKSTATE LICENSE

General Provider Information

NPI Number : 1700104015
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHERISA WARREN D.O.
Provider Business Mailing Address
First Line : PO BOX 258857
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73125-8857
Country : US
Telephone Number : 405-241-3539
Fax Number : 405-241-0998
Provider Business Practice Location Address
First Line : 3200 QUAIL SPRINGS PKWY STE 200
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73134-2699
Country : US
Telephone Number : 405-701-9880
Fax Number : 405-701-9881
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2010
Last Update Date : 05/17/2021

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Directions to “ DR. SHERISA WARREN D.O.” Practice Location

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