Individual
JOHN MARK FANNIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4600 N DAVIS HIGHWAY, PENSACOLA, FL 32503
(850) 477-9073
(850) 494-0065
Mailing address
4600 NORTH DAVIS HIGHWAY, PENSACOLA, FL 32503
(850) 477-9073
(850) 494-0065
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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