Provider Demographics
NPI:1073704326
Name:WARNER, GREGORY YERVANT (DO)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:YERVANT
Last Name:WARNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1010 NUT TREE RD
Mailing Address - Street 2:SUITE 100B
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-4172
Mailing Address - Country:US
Mailing Address - Phone:707-624-7999
Mailing Address - Fax:707-624-7998
Practice Address - Street 1:1010 NUT TREE RD
Practice Address - Street 2:SUITE 100B
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-4172
Practice Address - Country:US
Practice Address - Phone:707-624-7999
Practice Address - Fax:707-624-7998
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A9902207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine