Provider Demographics
NPI:1801973508
Name:WARREN, JAMES LARRY (NBC-HIS)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:LARRY
Last Name:WARREN
Suffix:
Gender:M
Credentials:NBC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 N OUTER RD
Mailing Address - Street 2:P O BOX 445
Mailing Address - City:DEXTER
Mailing Address - State:MO
Mailing Address - Zip Code:63841-0445
Mailing Address - Country:US
Mailing Address - Phone:573-624-6214
Mailing Address - Fax:573-624-2202
Practice Address - Street 1:2102 N OUTER RD
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MO
Practice Address - Zip Code:63841-8482
Practice Address - Country:US
Practice Address - Phone:573-624-6214
Practice Address - Fax:573-624-2202
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO463237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist