Provider Demographics
NPI:1346447109
Name:NELSON A WARNER MD PA
Entity type:Organization
Organization Name:NELSON A WARNER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:A
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-294-7558
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME24617207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN2617Medicare PIN
FLD55764Medicare UPIN