Provider Demographics
NPI:1821245424
Name:WARREN, RANDALL JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:JAMES
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 1:720 CORTARO DR
Mailing Address - Street 2:
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33573-6811
Mailing Address - Country:US
Mailing Address - Phone:833-320-7426
Mailing Address - Fax:833-282-8899
Practice Address - Street 1:720 CORTARO DR
Practice Address - Street 2:DEPT OF ANESTHESIOLOGY, VAMC
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-3357
Practice Address - Country:US
Practice Address - Phone:833-320-7246
Practice Address - Fax:833-282-8899
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088532207L00000X
FLME108567207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology