Provider Demographics
NPI:1992796056
Name:WARREN, NEIL JAY (DPM)
Entity type:Individual
Prefix:DR
First Name:NEIL
Middle Name:JAY
Last Name:WARREN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 E LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-1918
Mailing Address - Country:US
Mailing Address - Phone:941-906-1050
Mailing Address - Fax:941-906-1049
Practice Address - Street 1:428 E LAKE DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-1918
Practice Address - Country:US
Practice Address - Phone:941-906-1050
Practice Address - Fax:941-906-1049
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2065213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT96820Medicare UPIN