Provider Demographics
NPI:1134160294
Name:WARREN, SCOTT DAVIS (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:DAVIS
Last Name:WARREN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6890 BELFORT OAKS PL
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-6241
Mailing Address - Country:US
Mailing Address - Phone:904-296-1313
Mailing Address - Fax:904-482-4060
Practice Address - Street 1:6890 BELFORT OAKS PL
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6241
Practice Address - Country:US
Practice Address - Phone:904-296-1313
Practice Address - Fax:904-482-4060
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64364207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL18982YMedicare ID - Type Unspecified
C74299Medicare UPIN