Provider Demographics
NPI:1851552806
Name:WARNER, LARRY WEDELL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:WEDELL
Last Name:WARNER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:10517 KENTSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-2853
Mailing Address - Country:US
Mailing Address - Phone:225-456-2884
Mailing Address - Fax:225-456-2892
Practice Address - Street 1:10517 KENTSHIRE CT
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-2853
Practice Address - Country:US
Practice Address - Phone:225-456-2884
Practice Address - Fax:225-456-2892
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA2035452084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1035912Medicaid
LA1035912Medicaid