Provider Demographics
NPI:1265542229
Name:WARNER, JEANNETTE G (MD)
Entity type:Individual
Prefix:DR
First Name:JEANNETTE
Middle Name:G
Last Name:WARNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1270 MALABAR RD SE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-2556
Mailing Address - Country:US
Mailing Address - Phone:321-722-1933
Mailing Address - Fax:321-722-0744
Practice Address - Street 1:1270 MALABAR RD SE
Practice Address - Street 2:SUITE 1
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-2556
Practice Address - Country:US
Practice Address - Phone:321-722-1933
Practice Address - Fax:321-722-0744
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2017-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 63433207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59-3444276OtherTAX IDENTIFICATION
FLC33346Medicare UPIN
FL25118Medicare ID - Type Unspecified