Provider Demographics
NPI:1063617942
Name:WARREN, LAKRYSTAL J (MD)
Entity type:Individual
Prefix:
First Name:LAKRYSTAL
Middle Name:J
Last Name:WARREN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2111 GLENWOOD DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3328
Mailing Address - Country:US
Mailing Address - Phone:407-478-6249
Mailing Address - Fax:407-478-6250
Practice Address - Street 1:2111 GLENWOOD DR
Practice Address - Street 2:SUITE 208
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3328
Practice Address - Country:US
Practice Address - Phone:407-478-6249
Practice Address - Fax:407-478-6250
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2011-09-07
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Provider Licenses
StateLicense IDTaxonomies
FLME108432207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFD789ZMedicare PIN