Provider Demographics
NPI:1366421729
Name:WARREN, STEVEN EDWARD (MD DPA)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:EDWARD
Last Name:WARREN
Suffix:
Gender:M
Credentials:MD DPA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 540552
Mailing Address - Street 2:
Mailing Address - City:N SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-0552
Mailing Address - Country:US
Mailing Address - Phone:801-652-8613
Mailing Address - Fax:801-936-0473
Practice Address - Street 1:4790 HIDDEN LAKE DR
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-6083
Practice Address - Country:US
Practice Address - Phone:801-652-8613
Practice Address - Fax:801-936-0473
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT168632-1205207QG0300X, 207QA0401X, 207QH0002X, 207QS1201X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000011718Medicare ID - Type Unspecified
UTD24885Medicare UPIN