Provider Demographics
NPI:1639285711
Name:GREMMEL, WARREN WALTER JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:WALTER
Last Name:GREMMEL
Suffix:JR
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 1:301 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-4861
Mailing Address - Country:US
Mailing Address - Phone:337-462-5227
Mailing Address - Fax:337-462-5228
Practice Address - Street 1:301 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-4861
Practice Address - Country:US
Practice Address - Phone:337-462-5227
Practice Address - Fax:337-462-5228
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11483R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA11483ROtherMEDICAL LICENSE #