Individual
DR. JAMIE ALLEN WARREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD, MD
Contact information
Practice address
2800 CANNONS LN STE 200, LOUISVILLE, KY 40205
(502) 454-4885
(502) 452-1926
Mailing address
2800 CANNONS LN STE 200, LOUISVILLE, KY 40205-2164
(502) 454-4885
(502) 452-1926
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
8142
KY
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
8142
KY
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
44040
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201055760
—
IN
05
—
7100152170
—
KY
05
—
7100154720
—
KY
01
—
P01500679
RAILROAD MEDICARE
KY
Enumeration date
02/13/2007
Last updated
08/07/2018
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