Provider Demographics
NPI:1265429989
Name:WARMUTH, MARC A (MD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:A
Last Name:WARMUTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7015 AC SKINNER PARKWAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256
Mailing Address - Country:US
Mailing Address - Phone:904-363-2113
Mailing Address - Fax:904-538-3672
Practice Address - Street 1:121 WHITEHALL DR
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5266
Practice Address - Country:US
Practice Address - Phone:904-825-4500
Practice Address - Fax:904-825-3672
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 73421207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL41977OtherBCBS
FL248299OtherAVMED
FL5406652OtherAETNA
FL255201900Medicaid
FL41977AMedicare PIN
FL248299OtherAVMED
FLG61363Medicare UPIN
FLP00215156Medicare PIN
FL41977UMedicare PIN