Provider Demographics
NPI:1093719841
Name:WARREN, RODERICK LANCE (MD)
Entity Type:Individual
Prefix:DR
First Name:RODERICK
Middle Name:LANCE
Last Name:WARREN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 SAINT MARYS DR
Mailing Address - Street 2:STE 303
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-0522
Mailing Address - Country:US
Mailing Address - Phone:812-477-1560
Mailing Address - Fax:812-477-1595
Practice Address - Street 1:801 SAINT MARYS DR
Practice Address - Street 2:STE 303
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0522
Practice Address - Country:US
Practice Address - Phone:812-477-1560
Practice Address - Fax:812-477-1595
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010433052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200019230Medicaid
INF99398Medicare UPIN
IN200019230Medicaid