Provider Demographics
NPI:1316953912
Name:WARNER, NELSON ALFRED (MD)
Entity type:Individual
Prefix:
First Name:NELSON
Middle Name:ALFRED
Last Name:WARNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 2ND ST NW
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4168
Mailing Address - Country:US
Mailing Address - Phone:863-294-7558
Mailing Address - Fax:863-295-9282
Practice Address - Street 1:429 2ND ST NW
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4168
Practice Address - Country:US
Practice Address - Phone:863-294-7558
Practice Address - Fax:863-295-9282
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME24617207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL071907203OtherMEDICARE RAILROAD
FLAI090Medicare PIN
FL071907203OtherMEDICARE RAILROAD