Provider Demographics
NPI:1144380056
Name:WARNER, RANDY T (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:T
Last Name:WARNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7451 WILES RD STE 102-103
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-2099
Mailing Address - Country:US
Mailing Address - Phone:954-340-0173
Mailing Address - Fax:561-931-0848
Practice Address - Street 1:7451 WILES RD STE 102-103
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-2099
Practice Address - Country:US
Practice Address - Phone:954-340-0173
Practice Address - Fax:561-931-0848
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1585362084P0800X
GA0539052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA331834718AMedicaid
GA331834718AMedicaid