Provider Demographics
NPI:1225056872
Name:WARREN, JEFFERY STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:STEVEN
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:PO BOX 197593
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37219-7593
Mailing Address - Country:US
Mailing Address - Phone:901-844-2500
Mailing Address - Fax:901-844-1439
Practice Address - Street 1:177 N HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-4747
Practice Address - Country:US
Practice Address - Phone:901-844-2500
Practice Address - Fax:901-844-1439
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD19075207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3703214Medicaid
B00176Medicare UPIN
TN3038985Medicare ID - Type Unspecified