Provider Demographics
NPI:1174521751
Name:WARNER, MATTHEW ARNOLD (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ARNOLD
Last Name:WARNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6044 DOCTORS PARK RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-4043
Mailing Address - Country:US
Mailing Address - Phone:850-626-0373
Mailing Address - Fax:850-626-8181
Practice Address - Street 1:6044 DOCTORS PARK RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-4043
Practice Address - Country:US
Practice Address - Phone:850-626-0373
Practice Address - Fax:850-626-8181
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65994207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45147OtherBC BS GROUP NUMBER
FLP00168822OtherRAILROAD MEDICARE
FL376736100Medicaid
FLK0876OtherMEDICARE GROUP NUMBER
AL59174493OtherBC BS AL
FL25360OtherBLUE CROSS BLUE SHIELD FL
FL25360OtherBLUE CROSS BLUE SHIELD FL
FL376736100Medicaid
AL59174493OtherBC BS AL