Provider Demographics
NPI:1548368020
Name:WARNER, JUSTIN D (MD)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:D
Last Name:WARNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: MANAGED CARE DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:2335 TAMIAMI TRAIL N
Practice Address - Street 2:SUITE 501
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-4456
Practice Address - Country:US
Practice Address - Phone:239-263-0011
Practice Address - Fax:239-430-7823
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2017-04-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME90326208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270653900Medicaid
FL7065622OtherAETNA
FLP953716OtherOPTIMUM
FLP00877441OtherRR MEDICARE
FLP01808780OtherCLEAR HEALTH
FL49098OtherBCBS
FLP112648OtherFREEDOM
FLP01808780OtherMOLINA
FL343966OtherAVMED
FLP01808780OtherCLEAR HEALTH
FLP01808780OtherMOLINA
FL49098XMedicare PIN
FL7065622OtherAETNA