Individual
LAWRENCE WARREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
3109 6TH AVE, FORT WORTH, TX 76110-3800
(817) 921-5339
Mailing address
3109 6TH AVE, FORT WORTH, TX 76110-3800
(817) 921-5339
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
0465
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
018790801
—
TX
01
—
8AJ098
BLUE CROSS BLUE SHIELD
TX
01
—
8F8751
MEDICARE
TX
Enumeration date
07/07/2006
Last updated
02/16/2010
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