Provider Demographics
NPI:1164635272
Name:WARNER, MILO NELSON (DO)
Entity Type:Individual
Prefix:
First Name:MILO
Middle Name:NELSON
Last Name:WARNER
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 1:365 COUNTY ROAD 301
Mailing Address - Street 2:
Mailing Address - City:EUREKA SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72632-9196
Mailing Address - Country:US
Mailing Address - Phone:479-253-2729
Mailing Address - Fax:
Practice Address - Street 1:214 CARTER ST
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:AR
Practice Address - Zip Code:72616-4303
Practice Address - Country:US
Practice Address - Phone:870-423-3355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR-4534208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AW1304512OtherDEA REGISTRATION NUMBER
AW1304512OtherDEA REGISTRATION NUMBER
E39974Medicare UPIN