Provider Demographics
NPI:1366468696
Name:WARNER, JAMES DUDLEY (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DUDLEY
Last Name:WARNER
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 1:8357 FREDERICK CT
Mailing Address - Street 2:
Mailing Address - City:DE SOTO
Mailing Address - State:KS
Mailing Address - Zip Code:66018-7129
Mailing Address - Country:US
Mailing Address - Phone:913-585-9935
Mailing Address - Fax:785-832-4887
Practice Address - Street 1:2415 MASSACHUSETTS ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66046-4827
Practice Address - Country:US
Practice Address - Phone:785-832-4842
Practice Address - Fax:785-832-4887
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI49207-020207Q00000X
KSKS 04-32933207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine