MEDICARE: ANN MARY JOHN M.D.

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	207ND0101X	MOHS-Micrographic Surgery Physician	ME148344	FL

General Provider Information

NPI Number	:	1922461219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN MARY JOHN M.D.

Provider Business Mailing Address
First Line	:	2750 SW 37TH AVE FL 1
Second Line	:
City	:	COCONUT GROVE
State	:	FL
Zip	:	33133-2764
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2750 SW 37TH AVE FL 1
Second Line	:
City	:	COCONUT GROVE
State	:	FL
Zip	:	33133-2764
Country	:	US
Telephone Number	:	305-774-7001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2016
Last Update Date	:	01/10/2023

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