Provider Demographics
NPI:1700104346
Name:WARNER, EVAN JARED (MD)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:JARED
Last Name:WARNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2870 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-3611
Mailing Address - Country:US
Mailing Address - Phone:608-263-7171
Mailing Address - Fax:
Practice Address - Street 1:5249 E TERRACE DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53718
Practice Address - Country:US
Practice Address - Phone:608-263-7171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2020-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015017959207W00000X
WI56408207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology