Healthcare Provider Details

I. General information

NPI: 1184662785
Provider Name (Legal Business Name): SCOTT D WARREN MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6890 BELFORT OAKS PL
JACKSONVILLE FL
32216-6241
US

IV. Provider business mailing address

6890 BELFORT OAKS PL
JACKSONVILLE FL
32216-6241
US

V. Phone/Fax

Practice location:
  • Phone: 904-296-1313
  • Fax:
Mailing address:
  • Phone: 904-296-1313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME64364
License Number StateFL

VIII. Authorized Official

Name: SHARON BUTLER
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 904-482-4050