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General NPI Number Information
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NPI Number | 1174627459
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Entity Type | Organization
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Legal Business Name | ANAZIA MEDICAL II, INC.
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Dates
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Enumeration Date | 09/08/2006
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Last Update Date | 10/29/2010
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Provider Practice Location Address
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Address Line | 1264 MAIN STREET SUITE A
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City | FAYETTE
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State | MS
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Zip | 39069
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Country | US
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Telephone | 601-786-0390
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Fax | 601-786-0730
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Provider Business Mailing Address
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Address Line | 120 5TH AVENUE
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City | MCCOMB
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State | MS
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Zip | 39648
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Country | US
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Telephone | 601-249-0013
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Fax | 601-249-0592
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Authorized Official
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Title or Position | CEO
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Name | DR. VICTOR O ANAZIA
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Credential | D.O.
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Telephone | 601-249-0013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 14997
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License Number State | MS
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