Provider Demographics
NPI:1255502431
Name:DANIEL A WARNER, M.D., P.A.
Entity type:Organization
Organization Name:DANIEL A WARNER, M.D., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:904-687-1164
Mailing Address - Street 1:570 MEMORIAL CIR STE 140
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5063
Mailing Address - Country:US
Mailing Address - Phone:904-687-1164
Mailing Address - Fax:386-220-9638
Practice Address - Street 1:570 MEMORIAL CIR STE 140
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5063
Practice Address - Country:US
Practice Address - Phone:904-687-1164
Practice Address - Fax:386-220-9638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270969400Medicaid
FLK6154Medicare PIN
FLG14408Medicare UPIN