Individual
JOHN MARK FANNIN
Active
Individual
JOHN MARK FANNIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
ME96388
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009939839
—
AL
05
—
276437700
—
FL
01
—
56071
BLUE CROSS BLUE SHIELD
FL
01
—
591-89048
BLUE CROSS BLUE SHIELD
AL
Enumeration date
07/31/2006
Last updated
04/01/2011
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