Provider Demographics
NPI:1457313033
Name:STRUDWICK, WARREN J JR (MD)
Entity Type:Individual
Prefix:MR
First Name:WARREN
Middle Name:J
Last Name:STRUDWICK
Suffix:JR
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 1:5900 HOLLIS STREET # K
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608
Mailing Address - Country:US
Mailing Address - Phone:510-922-1614
Mailing Address - Fax:510-922-8564
Practice Address - Street 1:5900 HOLLIS STREET # K
Practice Address - Street 2:
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608
Practice Address - Country:US
Practice Address - Phone:510-922-1614
Practice Address - Fax:510-922-8564
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52222207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA121708OtherDEPT OF LABOR & INDUSTRIE
349617200OtherU.S. DEPT OF LABOR
349617200OtherU.S. DEPT OF LABOR
00G522220Medicare ID - Type Unspecified
E91893Medicare UPIN