Provider Demographics
NPI:1093712275
Name:WARBRITTON, DUSTIN (DO)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:
Last Name:WARBRITTON
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 1:1500 SOUTHWEST BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-2432
Mailing Address - Country:US
Mailing Address - Phone:573-635-6350
Mailing Address - Fax:573-635-9049
Practice Address - Street 1:1500 SOUTHWEST BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-2432
Practice Address - Country:US
Practice Address - Phone:573-635-6350
Practice Address - Fax:573-635-9049
Is Sole Proprietor?:No
Enumeration Date:2005-07-04
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODO10848207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO243931912Medicaid
MO003013752Medicare ID - Type Unspecified
MOG80152Medicare UPIN