Healthcare Provider Details

I. General information

NPI: 1467463901
Provider Name (Legal Business Name): JOHN BENJAMIN WARBURTON MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

829 ARMISTEAD ST. 43 MDOS/SGOH
POPE AFB NC
28308
US

IV. Provider business mailing address

209 COBBLESTONE DR.
SPRING LAKE NC
28390
US

V. Phone/Fax

Practice location:
  • Phone: 910-394-4700
  • Fax:
Mailing address:
  • Phone: 336-210-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: