MEDICARE: DR. MARK G WARREN D.P.M

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	213E00000X	Podiatrist	PO1194	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457460396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK G WARREN D.P.M

Provider Business Mailing Address
First Line	:	821 S.W. 36TH AVE
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435
Country	:	US
Telephone Number	:	561-369-3300
Fax Number	:	561-734-2811

Provider Business Practice Location Address
First Line	:	1325 S CONGRESS AVE
Second Line	:	SUITE 108
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-5876
Country	:	US
Telephone Number	:	561-369-3300
Fax Number	:	561-734-2811

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/25/2013

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