MEDICARE: JAMES WARREN WASHBURN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	6510A	WY

General Provider Information

NPI Number	:	1437183019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES WARREN WASHBURN D.O.

Provider Business Mailing Address
First Line	:	2804 W MARC KNIGHTON CT
Second Line	:	VA CLINIC
City	:	LECANTO
State	:	FL
Zip	:	34461-6300
Country	:	US
Telephone Number	:	352-746-8000
Fax Number	:	352-746-8002

Provider Business Practice Location Address
First Line	:	2804 W MARC KNIGHTON CT
Second Line	:	VA CLINIC
City	:	LECANTO
State	:	FL
Zip	:	34461-6300
Country	:	US
Telephone Number	:	352-746-8000
Fax Number	:	352-746-8002

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	08/24/2009

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