Provider Demographics
NPI:1457337594
Name:WARNOCK, STEVEN H (MD)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:H
Last Name:WARNOCK
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 1:11762 SOUTH STATE ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-4000
Mailing Address - Country:US
Mailing Address - Phone:801-571-2020
Mailing Address - Fax:801-571-6899
Practice Address - Street 1:11762 SOUTH STATE ST
Practice Address - Street 2:SUITE 220
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-4000
Practice Address - Country:US
Practice Address - Phone:801-571-2020
Practice Address - Fax:801-571-6899
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT263363-1205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY116131800Medicaid
MT0000027781Medicaid
ID805412400Medicaid
NM50621017Medicaid
NV002082075Medicaid
MT0000027781Medicaid
005775201Medicare ID - Type Unspecified
240007443Medicare ID - Type UnspecifiedRAILROAD MEDICARE