Provider Demographics
NPI:1235245028
Name:WALTER G WARREN DPM, PC
Entity Type:Organization
Organization Name:WALTER G WARREN DPM, PC
Other - Org Name:COMPREHENSIVE FOOT & ANKLE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:G
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:812-524-3338
Mailing Address - Street 1:PO BOX 707
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-0707
Mailing Address - Country:US
Mailing Address - Phone:812-524-3338
Mailing Address - Fax:812-524-3337
Practice Address - Street 1:1239 E 4TH STREET RD
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-1839
Practice Address - Country:US
Practice Address - Phone:812-524-3338
Practice Address - Fax:812-524-3337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000678213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN380042POtherSIHO
IN0369030001OtherDMERC
IN000000092305OtherBCBS
IN480024209OtherPALMETTO GBA RAILROAD
IN100140790AMedicaid
IN000000092305OtherBCBS
IN0369030001Medicare NSC