Provider Demographics
NPI:1568081495
Name:WARREN, JACOB D (MD)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:D
Last Name:WARREN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 DOUGLAS CIR
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-4536
Mailing Address - Country:US
Mailing Address - Phone:423-762-9223
Mailing Address - Fax:
Practice Address - Street 1:1300 DOUGLAS CIR
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4536
Practice Address - Country:US
Practice Address - Phone:423-762-9223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-10
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA90252171000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No171000000XOther Service ProvidersMilitary Health Care Provider