Provider Demographics
NPI:1801870936
Name:WARREN, DIRK A (MD)
Entity type:Individual
Prefix:DR
First Name:DIRK
Middle Name:A
Last Name:WARREN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 477 BOX 2
Mailing Address - Street 2:
Mailing Address - City:FPO AP
Mailing Address - State:NAF ATSUGI
Mailing Address - Zip Code:96306
Mailing Address - Country:JP
Mailing Address - Phone:0118146-763-4692
Mailing Address - Fax:
Practice Address - Street 1:PSC 477 BOX 2
Practice Address - Street 2:
Practice Address - City:FPO AP
Practice Address - State:NAF ATSUGI
Practice Address - Zip Code:96306
Practice Address - Country:JP
Practice Address - Phone:0118146-763-4692
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00607232083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine