Provider Demographics
NPI:1407805567
Name:WARR, OTIS S III (MD)
Entity Type:Individual
Prefix:
First Name:OTIS
Middle Name:S
Last Name:WARR
Suffix:III
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 1:6025 WALNUT GROVE RD
Mailing Address - Street 2:SUITE 607
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2131
Mailing Address - Country:US
Mailing Address - Phone:901-684-1909
Mailing Address - Fax:901-821-0733
Practice Address - Street 1:6025 WALNUT GROVE RD
Practice Address - Street 2:SUITE 607
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2131
Practice Address - Country:US
Practice Address - Phone:901-684-1909
Practice Address - Fax:901-821-0733
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD4870207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNB59136Medicare UPIN
TN3120343Medicare ID - Type Unspecified