Provider Demographics
NPI:1780607390
Name:WARNER, JOHN SLOAN JR (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:SLOAN
Last Name:WARNER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2701
Mailing Address - Country:US
Mailing Address - Phone:859-258-4271
Mailing Address - Fax:859-258-4296
Practice Address - Street 1:1221 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2701
Practice Address - Country:US
Practice Address - Phone:859-258-4271
Practice Address - Fax:859-258-4296
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32614208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64326143Medicaid
KY37903705OtherMEDICAID LAB GRP
KY020032739OtherRR MEDICARE PIN
KY4000501OtherMEDICARE LAB GRP
KYCB5773OtherRR MEDICARE GROUP NUMBER
KY36000818OtherMEDICAID ASC GRP
KYASC1019OtherMEDICARE ASC GRP
KY37903705OtherMEDICAID LAB GRP
KY0091166Medicare ID - Type Unspecified
KY0169Medicare PIN