Individual
DR. OTIS SUMTER WARR IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
555 W 6TH ST, MOUNTAIN HOME, AR 72653-3409
(870) 425-8288
(870) 425-8299
Mailing address
555 W 6TH ST, MOUNTAIN HOME, AR 72653-3409
(870) 425-8288
(870) 425-8299
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
E3744
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03120015100
QUAL CHOICE #
AR
05
—
150550001
—
AR
01
—
5M662
AR BCBS #
AR
01
—
A005
CHAMPUS/TRICARE #
AR
Enumeration date
06/02/2005
Last updated
02/29/2008
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