Healthcare Provider Details

I. General information

NPI: 1730286865
Provider Name (Legal Business Name): JOHN LOVELL WARWICK JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 03/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 WEST GRANGER AVE
MODESTO CA
95350-4425
US

IV. Provider business mailing address

205 WEST GRANGER AVE
MODESTO CA
95350-4425
US

V. Phone/Fax

Practice location:
  • Phone: 209-579-9930
  • Fax: 209-579-9941
Mailing address:
  • Phone: 209-579-9930
  • Fax: 209-579-9941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG69711
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: