Provider Demographics
NPI:1902877152
Name:WARREN, ROGER DRURY (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:DRURY
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 1:205 S HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:KS
Mailing Address - Zip Code:66945-8924
Mailing Address - Country:US
Mailing Address - Phone:785-337-2214
Mailing Address - Fax:785-337-2727
Practice Address - Street 1:205 S HANOVER ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:KS
Practice Address - Zip Code:66945-0038
Practice Address - Country:US
Practice Address - Phone:785-337-2214
Practice Address - Fax:785-337-2727
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-11294207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100083660BMedicaid
KSB68538Medicare UPIN
KS055503Medicare ID - Type Unspecified