Provider Demographics
NPI:1740423342
Name:WARREN, ROBERT FREDERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:FREDERIC
Last Name:WARREN
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 1:113 POMONA LANDING RD
Mailing Address - Street 2:
Mailing Address - City:POMONA PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32181-2211
Mailing Address - Country:US
Mailing Address - Phone:386-546-4466
Mailing Address - Fax:
Practice Address - Street 1:113 POMONA LANDING RD
Practice Address - Street 2:
Practice Address - City:POMONA PARK
Practice Address - State:FL
Practice Address - Zip Code:32181-2211
Practice Address - Country:US
Practice Address - Phone:386-546-4466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-13
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 97194207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D99913Medicare UPIN