Mark Brandon Warren, MD
Individual provider Active NPI Psychiatry Physician · Boise, ID
NPI 1982925319 · NPPES record last updated Sep 18, 2023
Key facts
- NPI
- 1982925319
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatry Physician 2084P0800X
- License
- 54313 (MN)
- Practice address
- 444 W Fort St
FL. 2
Boise, ID 83702-4535 - Phone
- (208) 422-1018
- NPI assigned
- Jun 21, 2010
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 54313 | MN | MD | Psychiatry Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 54313 | MN | Yes |
Addresses
Primary practice location
444 W Fort St
FL. 2
Boise, ID 83702-4535
Mailing address
444 W Fort St
FL. 2
Boise, ID 83702-4535
Phone (208) 422-1018
Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 18, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.