Organization
AMA MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CRUZ MARTINA FANA-SOUCHET M.D. (PRESIDENT/MEDICAL DIRECTOR)
(727) 331-8740
Entity
Organization
Contact information
Practice address
125 PATRICIA AVE, UNITS B & D, DUNEDIN, FL 34698-8100
(727) 331-8740
(727) 331-8744
Mailing address
PO BOX 306, PALM HARBOR, FL 34682-0306
(727) 331-8740
(727) 331-8744
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME 96750
FL
207RI0200X
Infectious Disease Physician
ME 96750
FL
Other
Enumeration date
06/29/2010
Last updated
11/06/2012
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