Provider Demographics
NPI:1255506358
Name:WARRICK, ADRIENNE BUCKMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ADRIENNE
Middle Name:BUCKMAN
Last Name:WARRICK
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:PO BOX 44008
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3660
Mailing Address - Fax:904-244-3425
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-5431
Practice Address - Fax:904-244-4908
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2013-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRESIDENTPHYSICIANPG1207L00000X
NY263970-1207L00000X
FLME 113306207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009032200Medicaid
GA003135444AMedicaid
FL14P99OtherBCBS
FLHL254ZMedicare PIN