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Organization
MARIANNA MEDICAL ASSOCIATES INC
Active
Organization
MARIANNA MEDICAL ASSOCIATES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL E FULMER MD (PRESIDENT)
(850) 372-4460
Entity
Organization
Contact information
Practice address
4349 LAFAYETTE ST, MARIANNA, FL 32446-2915
(850) 372-4460
(850) 372-4461
Mailing address
4349 LAFAYETTE ST, MARIANNA, FL 32446-2915
(850) 372-4460
(850) 372-4461
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
259105700
—
FL
01
—
45308
BLUE CROSS BLUE SHIELD
FL
01
—
6SALA
BLUE CROSS CLUE SHIELD
FL
Enumeration date
01/26/2007
Last updated
07/21/2022
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