Provider Demographics
NPI:1710918180
Name:WARNER, CANDACE B (MD)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:B
Last Name:WARNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5867 HYACINTH AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-8848
Mailing Address - Country:US
Mailing Address - Phone:225-767-9091
Mailing Address - Fax:225-767-9531
Practice Address - Street 1:2223 QUAIL RUN
Practice Address - Street 2:SUITE H-2
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-9063
Practice Address - Country:US
Practice Address - Phone:225-767-3663
Practice Address - Fax:225-767-9531
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2008-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.08680R207RI0200X
LAACU.C10010171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAF01238Medicare UPIN
LA5N708Medicare PIN