Healthcare Provider Details

I. General information

NPI: 1477971802
Provider Name (Legal Business Name): LOEL SCOTT WARSCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10244 S US HIGHWAY 1
PORT ST LUCIE FL
34952-5615
US

IV. Provider business mailing address

10244 S US HIGHWAY 1
PORT ST LUCIE FL
34952-5615
US

V. Phone/Fax

Practice location:
  • Phone: 866-228-7676
  • Fax:
Mailing address:
  • Phone: 866-228-7676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME136537
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: