Provider Demographics
NPI:1881648293
Name:HANKINS, WARREN TRACY (MD)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:TRACY
Last Name:HANKINS
Suffix:
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 1:2010 INJO DR
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5707
Mailing Address - Country:US
Mailing Address - Phone:928-854-5400
Mailing Address - Fax:928-854-5401
Practice Address - Street 1:2010 INJO DR
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5707
Practice Address - Country:US
Practice Address - Phone:928-854-5400
Practice Address - Fax:928-854-5401
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27481174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG93141Medicare UPIN