Healthcare Provider Details

I. General information

NPI: 1255798427
Provider Name (Legal Business Name): WARREN S. KLUGER, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2016
Last Update Date: 01/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 US 1 S
ST AUGUSTINE FL
32086-6351
US

IV. Provider business mailing address

1320 PRINCE RD
ST AUGUSTINE FL
32086-6536
US

V. Phone/Fax

Practice location:
  • Phone: 904-797-3686
  • Fax:
Mailing address:
  • Phone: 904-662-7544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License NumberTN-33842
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License NumberTN-33842
License Number StateFL

VIII. Authorized Official

Name: DR. WARREN S. KLUGER
Title or Position: SURGEON
Credential: MD, PA
Phone: 904-797-3686