Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | ME117773 | FL |
NPI | 1003109554 |
---|---|
Provider Name | Stewart Drew Warren |
First Address | Tallahassee, FL 32308-4614 |
Second Address | Tallahassee, FL 32308-4614 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2011 |
Last Update Date | 01/12/2020 |