Individual
DR. RANDY LEE WARREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1101 JOHNSON AVE, SUITE 204, MYRTLE BEACH, SC 29577-1893
(843) 477-0177
Mailing address
1101 JOHNSON AVE, SUITE 204, MYRTLE BEACH, SC 29577-1893
(843) 477-0177
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
21827
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002006862
BLUE CROSS/BLUE SHIELD
WV
05
—
381002129
—
WV
Enumeration date
08/31/2006
Last updated
09/30/2015
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