Organization
MEDICAL WELLNESS INSTITUTE OF AMERICA INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN MARK FANNIN MD (PRESIDENT)
(850) 932-5767
Entity
Organization
Contact information
Practice address
3575 GULF BREEZE PKWY, GULF BREEZE, FL 32563-3407
(850) 932-5767
(850) 932-5774
Mailing address
3575 GULF BREEZE PKWY, GULF BREEZE, FL 32563-3407
(850) 932-5767
(850) 932-5774
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
ME96388
FL
Other
Enumeration date
12/07/2011
Last updated
12/09/2011
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