Provider Demographics
NPI:1649287814
Name:WARNER, SIDNEY C (PA-C)
Entity type:Individual
Prefix:
First Name:SIDNEY
Middle Name:C
Last Name:WARNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 E EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-4414
Mailing Address - Country:US
Mailing Address - Phone:210-271-0606
Mailing Address - Fax:210-475-9806
Practice Address - Street 1:520 E EUCLID AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4414
Practice Address - Country:US
Practice Address - Phone:210-271-0606
Practice Address - Fax:210-475-9806
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1032363AM0700X
TXPA04377363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100511427Medicaid
NV100511427Medicaid
NV103499Medicare PIN