Provider Demographics
NPI:1528026523
Name:WARNER, ROBERT S (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:WARNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:12 HIGH ST
Mailing Address - Street 2:STE 102
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7676
Mailing Address - Country:US
Mailing Address - Phone:207-784-4539
Mailing Address - Fax:207-784-2868
Practice Address - Street 1:12 HIGH ST
Practice Address - Street 2:STE 102
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7676
Practice Address - Country:US
Practice Address - Phone:207-784-4539
Practice Address - Fax:207-784-2868
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME1020207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM372502Medicare UPIN
MEMM372501Medicare UPIN