Provider Demographics
NPI:1871602615
Name:WARREN, PAMELA A (MD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:A
Last Name:WARREN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1909 CYPRESS CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613
Mailing Address - Country:US
Mailing Address - Phone:512-250-9600
Mailing Address - Fax:512-250-0902
Practice Address - Street 1:1909 CYPRESS CREEK ROAD
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613
Practice Address - Country:US
Practice Address - Phone:512-250-9600
Practice Address - Fax:512-250-0902
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5750207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00QI58OtherBCBS
C23188Medicare UPIN
TX613421Medicare PIN