Individual
MAHER M FANOUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6831 NW 11TH PL, SUITE 1, GAINESVILLE, FL 32605-4259
(352) 331-7337
Mailing address
6831 NW 11TH PL, SUITE 1, GAINESVILLE, FL 32605-4259
(352) 331-7337
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME78921
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
257002500
—
FL
01
—
263997
AVMED
FL
01
—
49379
BLUE CROSS BLUE SHIELD
FL
Enumeration date
02/18/2008
Last updated
06/12/2008
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