Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 264172-1 | NY |
Y | 207L00000X | Anesthesiologist | ME 113050 | FL |
NPI | 1003081191 |
---|---|
Provider Name | Dr. Matthew Duwain Warrick |
First Address | Jacksonville, FL 32231-4008 |
Second Address | Jacksonville, FL 32209-6511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2008 |
Last Update Date | 13/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00135452A | (05) | GA |
009033700 | (05) | FL |
14PR6 | BCBS (01) | FL |