Provider Demographics
NPI:1366447914
Name:WARNER, PAUL S (DPM)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:S
Last Name:WARNER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2031 E MONTE VISTA DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-2859
Mailing Address - Country:US
Mailing Address - Phone:520-321-9898
Mailing Address - Fax:
Practice Address - Street 1:2031 E MONTE VISTA DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-2859
Practice Address - Country:US
Practice Address - Phone:520-321-9898
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ143213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZT42243Medicare UPIN