MEDICARE: DR. NEIL JAY 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	213EP1101X	Primary Podiatric Medicine Podiatrist	PO2065	FL

General Provider Information

NPI Number	:	1992796056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NEIL JAY WARREN D.P.M.

Provider Business Mailing Address
First Line	:	428 E LAKE DR
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34232-1918
Country	:	US
Telephone Number	:	941-906-1050
Fax Number	:	941-906-1049

Provider Business Practice Location Address
First Line	:	428 E LAKE DR
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34232-1918
Country	:	US
Telephone Number	:	941-906-1050
Fax Number	:	941-906-1049

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

Provider Enumeration Date	:	10/28/2005
Last Update Date	:	12/17/2007

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