Provider Information for 1770003642
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Mr. LARRY ALLISON WARREN Jr.
Sex: Male
NPI: 1770003642
Last Updated: 2018-03-17
Certification Date:
Certification Date:
Details
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NPI | 1770003642 | ||||||||
Enumeration Date | 2017-06-22 | ||||||||
NPI Type | NPI-1 Individual | ||||||||
Sole Proprietor | NO | ||||||||
Status | Active | ||||||||
Mailing Address | PO BOX 161585 ALTAMONTE SPRINGS, FL 32716-1585 United States Phone: 407-291-8009 | Fax:407-770-5503 | ||||||||
Primary Practice Address | 3544 EDGEWATER DR ORLANDO, FL 32804-2922 United States Phone: 407-291-8009 | Fax:407-770-5503 | ||||||||
Secondary Practice Address(es) | 3544 EDGEWATER DR | ||||||||
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