Provider Demographics
NPI:1043264716
Name:DOWNHOUR, WARREN J (DO,)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:J
Last Name:DOWNHOUR
Suffix:
Gender:M
Credentials:DO,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 N 51ST AVE
Mailing Address - Street 2:6
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85031-1237
Mailing Address - Country:US
Mailing Address - Phone:623-209-5555
Mailing Address - Fax:623-247-1905
Practice Address - Street 1:4700 N 51ST AVE
Practice Address - Street 2:6
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-1237
Practice Address - Country:US
Practice Address - Phone:623-209-5555
Practice Address - Fax:623-247-1905
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004028207Q00000X
AZ4628207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0728001Medicaid
OH080195135OtherRAILROAD MEDICARE
OH000000279843OtherANTHEM
OH080195135OtherRAILROAD MEDICARE
OH000000279843OtherANTHEM
OHDO0585774Medicare PIN
OHDO0585775Medicare ID - Type Unspecified