Individual
GERALD G. WARRENER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
104 NICHOLAS PL, AVILLA, IN 46710-0069
(260) 897-2520
(260) 897-3650
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01027892
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000365007
ANTHEM
IN
01
—
000000570557
ANTHEM
IN
05
—
10054680A
—
IN
01
—
P00632884
MEDICARE RAILROAD
IN
Enumeration date
09/13/2005
Last updated
10/20/2022
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