Provider Demographics
NPI:1275537755
Name:AMOS, WARREN R (MD)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:R
Last Name:AMOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:1026 MAR WALT DR
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6645
Practice Address - Country:US
Practice Address - Phone:850-863-5294
Practice Address - Fax:850-864-1648
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00607392085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL118460OtherALABAMA MEDICAID DSF 05/01/10
FL25224OtherBCBS PROVIDER NUMBER
FL009948645OtherAL. MCAID PSO PROVIDER #
AL009957635OtherAL. MCAID FWB PROVIDER #
FL375209700Medicaid
AL118462OtherALABAMA MEDICAID SRB 05/01/10
AL009957625OtherAL. MCAID CRO PROVIDER #
FL0185058OtherCIGNA PROVIDER NUMBER
FL36-00905OtherUTD. HLTHCR. PROVIDER #
AL118461OtherALABAMA MEDICAID FWB 05/01/10
FL373224OtherAVMED
AL009957645OtherAL. MCAID SRB PROVIDER #
FL5909067OtherAETNA THRU ECHA PROV. NUM
FL738889OtherFIRST HEALTH PROVIDER NUM
FLP-12004670OtherMULTIPLAN PROVIDER NUMBER
AL118455OtherALABAMA MEDICAID CRO 05/01/10
FL226045OtherWELLCARE
FLP12004670OtherMULTIPLAN PROVIDER NUMBER
AL118462OtherALABAMA MEDICAID SRB 05/01/10
FLP12004670OtherMULTIPLAN PROVIDER NUMBER