Provider Demographics
NPI:1942239272
Name:WARREN, KIMBERLY S (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
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 1:2801 LEMMON AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-2399
Mailing Address - Country:US
Mailing Address - Phone:214-754-0000
Mailing Address - Fax:214-379-1849
Practice Address - Street 1:2801 LEMMON AVE STE 400
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-2399
Practice Address - Country:US
Practice Address - Phone:214-754-0000
Practice Address - Fax:214-379-1849
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4341207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX119014204Medicaid
TX042040801Medicaid
TX8522K2Medicare PIN
TX042040801Medicaid
TX8339J2Medicare PIN
TX8073M1Medicare PIN
TX180041184Medicare PIN
TX180044841Medicare PIN