1679599542 NPI number — WARREN R SELMAN MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679599542 NPI number — WARREN R SELMAN MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

SELMAN

Provider First Name:

WARREN

Provider Middle Name:

R

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1679599542

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

11/06/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1001 NW 13TH ST STE 201

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

BOCA RATON

Provider Business Mailing Address State Name:

FL

Provider Business Mailing Address Postal Code:

33486-2269

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

561-955-6663

Provider Business Mailing Address Fax Number:

561-955-2879

Provider First Line Business Practice Location Address:

800 MEADOWS RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

BOCA RATON

Provider Business Practice Location Address State Name:

FL

Provider Business Practice Location Address Postal Code:

33486-2304

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

561-955-4600

Provider Business Practice Location Address Fax Number:

833-625-1604

Provider Enumeration Date:

07/14/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207T00000X , with the licence number:  35-042211 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207T00000X , with the licence number: ME163832 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 140003954 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 743393 . This is a "BUCKEYE MEDICAID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 000000523191 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 1022614010001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 363999 . This is a "WELLCARE MEDICAID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 000000130224 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 0560987 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
• Identifier: 000000221215 . This is a "UNISON" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 4007895 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: P00428936 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 120139000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".