Provider Demographics
NPI:1730286865
Name:WARWICK, JOHN LOVELL JR (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:LOVELL
Last Name:WARWICK
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:205 WEST GRANGER AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4425
Mailing Address - Country:US
Mailing Address - Phone:209-579-9930
Mailing Address - Fax:209-579-9941
Practice Address - Street 1:205 WEST GRANGER AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4425
Practice Address - Country:US
Practice Address - Phone:209-579-9930
Practice Address - Fax:209-579-9941
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2009-03-17
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Provider Licenses
StateLicense IDTaxonomies
CAG69711207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F17350Medicare UPIN