Provider Demographics
NPI:1245566025
Name:WARNER, MICHAEL W (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:WARNER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10290 US HIGHWAY 87 E
Mailing Address - Street 2:
Mailing Address - City:ADKINS
Mailing Address - State:TX
Mailing Address - Zip Code:78101-1906
Mailing Address - Country:US
Mailing Address - Phone:210-789-7455
Mailing Address - Fax:
Practice Address - Street 1:10290 US HIGHWAY 87 E
Practice Address - Street 2:
Practice Address - City:ADKINS
Practice Address - State:TX
Practice Address - Zip Code:78101-1906
Practice Address - Country:US
Practice Address - Phone:210-789-7455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-28
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01367363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant