Individual
JERRY G WARREN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
621 SE CASS AVE, SUITE 126, ROSEBURG, OR 97470-3123
(541) 580-0304
Mailing address
220 N RIVER DR, ROSEBURG, OR 97470-8009
(541) 672-0477
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD01895
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
261735
—
OR
Enumeration date
11/02/2005
Last updated
08/29/2014
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