Provider Demographics
NPI:1750347258
Name:WARR, SHELLEY J (MD)
Entity type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:J
Last Name:WARR
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 1:405 BUTTERCUP DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-2910
Mailing Address - Country:US
Mailing Address - Phone:870-425-3030
Mailing Address - Fax:870-508-8136
Practice Address - Street 1:405 BUTTERCUP DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2910
Practice Address - Country:US
Practice Address - Phone:870-425-3030
Practice Address - Fax:870-508-8136
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3745207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR152319001Medicaid
AR152319001Medicaid
AR5M649Medicare ID - Type Unspecified