Provider Demographics
NPI:1154389112
Name:WARREN, CHARLES R (DO)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:R
Last Name:WARREN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:6520 FORT CAROLINE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-2044
Mailing Address - Country:US
Mailing Address - Phone:904-745-3618
Mailing Address - Fax:904-722-4271
Practice Address - Street 1:4565 US HIGHWAY 17 STE 106
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4822
Practice Address - Country:US
Practice Address - Phone:904-269-4559
Practice Address - Fax:904-269-4597
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS7329207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL52244ZMedicare ID - Type Unspecified
FLI33001Medicare UPIN