Provider Demographics
NPI:1720059041
Name:WARREN, LINDA DUSTON (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:DUSTON
Last Name:WARREN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:JOSEPHINE
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:205 S HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:KS
Mailing Address - Zip Code:66945-0038
Mailing Address - Country:US
Mailing Address - Phone:785-337-2214
Mailing Address - Fax:785-337-2727
Practice Address - Street 1:205 S HANOVER ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:KS
Practice Address - Zip Code:66945-0038
Practice Address - Country:US
Practice Address - Phone:785-337-2214
Practice Address - Fax:785-337-2727
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-14707207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100081080AMedicaid
KS100081080AMedicaid
KSB91044Medicare UPIN