Provider Demographics
NPI:1275527954
Name:WARNER, JOAN MARY (MD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:MARY
Last Name:WARNER
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 1:5505 W CHANDLER BLVD
Mailing Address - Street 2:#B13
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-3683
Mailing Address - Country:US
Mailing Address - Phone:480-361-4780
Mailing Address - Fax:480-361-4781
Practice Address - Street 1:5505 W CHANDLER BLVD
Practice Address - Street 2:#B13
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-3683
Practice Address - Country:US
Practice Address - Phone:480-361-4780
Practice Address - Fax:480-361-4781
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-08
Last Update Date:2007-07-08
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-12
Provider Licenses
StateLicense IDTaxonomies
AZ27858207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ73375Medicare ID - Type Unspecified
H05779Medicare UPIN