Healthcare Provider Details

I. General information

NPI: 1194047142
Provider Name (Legal Business Name): WARREN S. KLUGER M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2010
Last Update Date: 12/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 US 1 S SUITE 2
ST AUGUSTINE FL
32086-6310
US

IV. Provider business mailing address

3100 US 1 S SUITE 2
ST AUGUSTINE FL
32086-6351
US

V. Phone/Fax

Practice location:
  • Phone: 904-797-2756
  • Fax:
Mailing address:
  • Phone: 904-797-2756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number00031145
License Number StateFL

VIII. Authorized Official

Name: DR. WARREN SYDNEY KLUGER
Title or Position: PRESIDENT
Credential: MD
Phone: 904-797-2756