Provider Demographics
NPI:1558399212
Name:WARREN, BETH G (MD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:G
Last Name:WARREN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2098 ACOSTA LN
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-6150
Mailing Address - Country:US
Mailing Address - Phone:972-316-2023
Mailing Address - Fax:972-378-6919
Practice Address - Street 1:6124 W PARKER RD
Practice Address - Street 2:SUITE 436
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8122
Practice Address - Country:US
Practice Address - Phone:972-378-5250
Practice Address - Fax:372-378-6919
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXM0963207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI 38668Medicare UPIN
TX8D8406Medicare ID - Type Unspecified