Provider Demographics
NPI:1902449804
Name:WARREN, STEPHEN L
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:L
Last Name:WARREN
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:STEPHEN
Other - Middle Name:L
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:STEPHEN L WARREN MD
Mailing Address - Street 1:4815 PRAIRIE VISTA DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-3779
Mailing Address - Country:US
Mailing Address - Phone:970-556-0562
Mailing Address - Fax:
Practice Address - Street 1:4815 PRAIRIE VISTA DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-3779
Practice Address - Country:US
Practice Address - Phone:970-556-0562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0036676207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology