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General NPI Number Information
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NPI Number | 1962532655
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Entity Type | Organization
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Legal Business Name | MARIANNA OB GYN ASSOCIATES P A
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 02/16/2012
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Provider Practice Location Address
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Address Line | 4230 HOSPITAL DR SUITE 209
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City | MARIANNA
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State | FL
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Zip | 32446-1955
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Country | US
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Telephone | 850-482-6484
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Fax | 850-482-5713
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Provider Business Mailing Address
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Address Line | 4230 HOSPITAL DRIVE SUITE 209
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City | MARIANNA
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State | FL
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Zip | 32446-1955
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Country | US
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Telephone | 850-482-6484
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Fax | 850-482-5713
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Authorized Official
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Title or Position | OWNER
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Name | DR. ORLANDO S MUNIZ
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Credential |
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Telephone | 850-482-6484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME0068116
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License Number State | FL
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