Provider Demographics
NPI:1447670286
Name:WARREN, HARRY III
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:
Last Name:WARREN
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 2ND AVE STE B1
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1790
Mailing Address - Country:US
Mailing Address - Phone:270-796-3330
Mailing Address - Fax:
Practice Address - Street 1:825 2ND AVE STE B1
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1790
Practice Address - Country:US
Practice Address - Phone:270-796-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-20
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP645208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)