Provider Demographics
NPI:1164514071
Name:WARRICK, ROBERT E (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:WARRICK
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 1:429 S ANGEL ST
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-3525
Mailing Address - Country:US
Mailing Address - Phone:801-544-2085
Mailing Address - Fax:801-544-2761
Practice Address - Street 1:3001 AVENUE A
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-2270
Practice Address - Country:US
Practice Address - Phone:620-225-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-13922207Q00000X
UT5712112-1204207Q00000X
ARR-4603207Q00000X
MO30850207Q00000X
ND6206207Q00000X
OK3392207Q00000X
WA1103207Q00000X
KS0513922207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100232320GMedicaid
KSKA1000005Medicare PIN
KSA08736Medicare UPIN