Basic Information
| Provider Information | |||||||||
| NPI: | 1407081185 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WARNER | ||||||||
| FirstName: | BRENT | ||||||||
| MiddleName: | THOMAS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1185 TOWN CENTRE DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | EAGAN | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551231188 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6519685042 | ||||||||
| FaxNumber: | 6519685904 | ||||||||
| Practice Location | |||||||||
| Address1: | 710 COMMERCE DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | WOODBURY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551254925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6519685042 | ||||||||
| FaxNumber: | 6519685904 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2009 | ||||||||
| LastUpdateDate: | 09/14/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 53280 | CO | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 390200000X | 156695 | NC | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207X00000X | 59611 | MN | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.