Individual
JOHN TRACY WARREN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11 POND VIEW DR, JERICHO, VT 05465-2030
(920) 435-1503
Mailing address
11 POND VIEW DR, JERICHO, VT 05465-2030
(920) 246-6288
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
29771
WI
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
29771-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31516000
—
WI
Enumeration date
07/12/2006
Last updated
11/23/2022
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