Provider Demographics
NPI:1508837006
Name:WARNER, ROBERT L JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:WARNER
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1000 W. KINGSHIGHIGHWAY
Mailing Address - Street 2:SUITE 14
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450
Mailing Address - Country:US
Mailing Address - Phone:870-239-8591
Mailing Address - Fax:870-239-8137
Practice Address - Street 1:1000 W. KINGSHIGHIGHWAY
Practice Address - Street 2:SUITE 13
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450
Practice Address - Country:US
Practice Address - Phone:870-239-8107
Practice Address - Fax:870-239-8115
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2020-12-04
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Provider Licenses
StateLicense IDTaxonomies
ARR4099208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR117604001Medicaid
53769Medicare ID - Type Unspecified