Provider Demographics
NPI:1073555389
Name:DAILEY, WARREN B (MD)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:B
Last Name:DAILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:WARREN
Other - Middle Name:B
Other - Last Name:DAILEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2305 SOUTHMORE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7416
Mailing Address - Country:US
Mailing Address - Phone:713-667-3999
Mailing Address - Fax:713-522-2247
Practice Address - Street 1:2305 SOUTHMORE BLVD STE A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7416
Practice Address - Country:US
Practice Address - Phone:713-667-3999
Practice Address - Fax:713-522-2247
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2012-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8454174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00RC08Medicare PIN