Provider Demographics
NPI:1114953387
Name:WARWICKE, LAUREL ANNE (MD)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:ANNE
Last Name:WARWICKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 NW 11TH PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-3144
Mailing Address - Country:US
Mailing Address - Phone:352-331-0900
Mailing Address - Fax:352-331-1511
Practice Address - Street 1:7000 NW 11TH PL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-3144
Practice Address - Country:US
Practice Address - Phone:352-331-0900
Practice Address - Fax:352-331-1511
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLME830462085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH45307OtherVISTA
FL06489OtherBLUE CROSS BLUE SHIELD
FL280321OtherAVMED
FL262043000Medicaid
FLH45307Medicare UPIN
FL262043000Medicaid