Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | ME64364 | FL |
Y | 207ND0101X | MOHS-Micrographic Surgeon | ME64364 | FL |
NPI | 1134160294 |
---|---|
Provider Name | Dr. Scott Davis Warren |
First Address | Jacksonville, FL 32216-6241 |
Second Address | Jacksonville, FL 32216-6241 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 17/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C74299 | (02) |