Provider Demographics
NPI:1750640496
Name:WARREN, RACHEL KAREN (MD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:KAREN
Last Name:WARREN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7711 LA AVENIDA DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-4330
Mailing Address - Country:US
Mailing Address - Phone:785-865-8266
Mailing Address - Fax:
Practice Address - Street 1:7777 FOREST LN STE C614
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6856
Practice Address - Country:US
Practice Address - Phone:972-566-7499
Practice Address - Fax:972-566-6428
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-15
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXR3003208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX389382802Medicaid