Basic Information
| Provider Information | |||||||||
| NPI: | 1407914195 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RODERICK L. WARREN, M.D., P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 SAINT MARYS DR | ||||||||
| Address2: | SUITE 303 EAST | ||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477140511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124771560 | ||||||||
| FaxNumber: | 8124771595 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 SAINT MARYS DR | ||||||||
| Address2: | SUITE 303 EAST | ||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477140511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124771560 | ||||||||
| FaxNumber: | 8124771595 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | WARREN | ||||||||
| AuthorizedOfficialFirstName: | RODERICK | ||||||||
| AuthorizedOfficialMiddleName: | LANCE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8124771560 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 50003851A | IN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.