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NPI Code Detail

MEDICARE: MR. DAVID GRAFTON FANNEY DO

MEDICARE: MR. DAVID GRAFTON FANNEY DO
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
1207Q00000XFamily Medicine PhysicianOS0005960FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1588637896
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DAVID GRAFTON FANNEY DO
Provider Business Mailing Address
First Line : 4241 NW AMERICAN LANE
Second Line :
City : LAKE CITY
State : FL
Zip : 32055
Country : US
Telephone Number : 386-752-2246
Fax Number : 386-758-7998
Provider Business Practice Location Address
First Line : 4241 NW AMERICAN LANE
Second Line :
City : LAKE CITY
State : FL
Zip : 32055
Country : US
Telephone Number : 386-752-2246
Fax Number : 386-758-7998
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2006
Last Update Date : 12/24/2009

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Directions to “ MR. DAVID GRAFTON FANNEY DO” Practice Location

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