Provider Demographics
NPI:1497801062
Name:WARSAW, TERRY JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:JAY
Last Name:WARSAW
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 1:20211 W VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93561-6748
Mailing Address - Country:US
Mailing Address - Phone:661-822-5544
Mailing Address - Fax:
Practice Address - Street 1:20211 W VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-6748
Practice Address - Country:US
Practice Address - Phone:661-822-5544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG35426207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G354260Medicaid
CA00G354260Medicare ID - Type Unspecified
CAA46349Medicare UPIN