MEDICARE: ANO & ANO MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	ME0029894	FL
2	207Q00000X	Family Medicine Physician	ME0020477	FL

General Provider Information

NPI Number	:	1083707079
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANO & ANO MD PA

Provider Business Mailing Address
First Line	:	2089 S RIDGEWOOD AVE
Second Line	:
City	:	SOUTH DAYTONA
State	:	FL
Zip	:	32119-2240
Country	:	US
Telephone Number	:	386-761-5682
Fax Number	:	386-760-4142

Provider Business Practice Location Address
First Line	:	2089 S RIDGEWOOD AVE
Second Line	:
City	:	SOUTH DAYTONA
State	:	FL
Zip	:	32119-2240
Country	:	US
Telephone Number	:	386-761-5682
Fax Number	:	386-760-4142

Authorized Official
Title or Position	:	PRESIDENT
Name	:	FERMIN ANO
Credential	:	MD
Telephone Number	:	386-761-5682

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	09/10/2007

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