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NPI Code Detail

MEDICARE: DR. ERIC JERMAINE WARREN M.D.

MEDICARE: DR. ERIC JERMAINE WARREN 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
12084P0800XPsychiatry Physician16517MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1730114117
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ERIC JERMAINE WARREN M.D.
Provider Business Mailing Address
First Line : PO BOX 88
Second Line :
City : BRANDON
State : MS
Zip : 39043-0088
Country : US
Telephone Number : 601-824-0342
Fax Number : 601-824-0349
Provider Business Practice Location Address
First Line : 613 MARQUETTE RD
Second Line :
City : BRANDON
State : MS
Zip : 39042-3038
Country : US
Telephone Number : 601-824-0342
Fax Number : 601-824-0349
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2006
Last Update Date : 01/08/2014

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