Provider Demographics
NPI:1255798427
Name:WARREN S. KLUGER, MD, PA
Entity type:Organization
Organization Name:WARREN S. KLUGER, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:KLUGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:904-797-3686
Mailing Address - Street 1:1320 PRINCE RD
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-6536
Mailing Address - Country:US
Mailing Address - Phone:904-662-7544
Mailing Address - Fax:
Practice Address - Street 1:3100 US 1 S
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-6351
Practice Address - Country:US
Practice Address - Phone:904-797-3686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTN-33842246QM0706X, 246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty
No246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical TechnologistGroup - Multi-Specialty