Provider Demographics
NPI:1255502431
Name:DANIEL A WARNER, M.D., P.A.
Entity Type:Organization
Organization Name:DANIEL A WARNER, M.D., P.A.
Other - Org Name:CONSULTIVE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HIV/AIDS PHYSICIAN-SPECIALIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-547-1056
Mailing Address - Street 1:1100 PLANTATION ISLAND DR S STE 230
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-5174
Mailing Address - Country:US
Mailing Address - Phone:904-687-1164
Mailing Address - Fax:941-444-5314
Practice Address - Street 1:1100 PLANTATION ISLAND DR S STE 230
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-5174
Practice Address - Country:US
Practice Address - Phone:904-687-1164
Practice Address - Fax:941-444-5314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066865174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270969400Medicaid
FLK6154Medicare PIN
FLG14408Medicare UPIN