Provider Demographics
NPI:1861658338
Name:JOHN C WARBURTON MD PA
Entity Type:Organization
Organization Name:JOHN C WARBURTON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:WARBURTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:850-863-2153
Mailing Address - Street 1:1034 MAR WALT DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6645
Mailing Address - Country:US
Mailing Address - Phone:850-863-2153
Mailing Address - Fax:
Practice Address - Street 1:1034 MAR WALT DR STE 100
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:850-863-2153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80359207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110221060OtherRAILROAD MEDICARE
FL35329OtherBCBS FL
FL2599942200Medicaid
FL5232980001Medicare NSC
FL5232980002Medicare NSC
FL35329Medicare PIN
FL110221060OtherRAILROAD MEDICARE
FLA39420Medicare UPIN