Provider Demographics
NPI:1194047142
Name:WARREN S. KLUGER M.D., P.A.
Entity type:Organization
Organization Name:WARREN S. KLUGER M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:SYDNEY
Authorized Official - Last Name:KLUGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-797-2756
Mailing Address - Street 1:3100 US 1 S
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-6351
Mailing Address - Country:US
Mailing Address - Phone:904-797-2756
Mailing Address - Fax:
Practice Address - Street 1:3100 US 1 S
Practice Address - Street 2:SUITE 2
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-6310
Practice Address - Country:US
Practice Address - Phone:904-797-2756
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00031145174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL79182Medicare UPIN