Provider Demographics
NPI:1447397484
Name:WARREN, HENRY C (DPM)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:C
Last Name:WARREN
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 1:200 S. JOHN REDDITT DR.
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904
Mailing Address - Country:US
Mailing Address - Phone:936-632-5252
Mailing Address - Fax:936-632-5284
Practice Address - Street 1:200 S. JOHN REDDITT DR.
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904
Practice Address - Country:US
Practice Address - Phone:936-632-5252
Practice Address - Fax:936-632-5284
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1590213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151321001Medicaid
TX8214B6Medicare ID - Type Unspecified
TX151321001Medicaid