Provider Demographics
NPI:1467437574
Name:WARNER, WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
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 1:6070 S FORT APACHE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5615
Mailing Address - Country:US
Mailing Address - Phone:702-803-5534
Mailing Address - Fax:
Practice Address - Street 1:6070 S FORT APACHE RD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5615
Practice Address - Country:US
Practice Address - Phone:702-803-5534
Practice Address - Fax:409-419-1108
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-12
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV21265207RI0200X
TXJ9932207PE0005X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127615603Medicaid
TXJ9932OtherTEXAS STATE LICENSE
TX127615606Medicaid
TX8189M0Medicare PIN
TX00796JMedicare PIN
TX127615603Medicaid
TX612783Medicare PIN