Organization Active NPI

Medical Wellness Institute of America Inc

  • Anesthesiology Physician
  • Gulf Breeze, FL
National Provider Identifier
1396013272
Registry record updated Dec 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
ME96388 Issued in FL
Legal business name
MEDICAL WELLNESS INSTITUTE OF AMERICA INC
Practice address
3575 Gulf Breeze Pkwy
Gulf Breeze, FL 32563-3407
Phone
(850) 932-5767
Fax
(850) 932-5774
NPI assigned
Dec 7, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
John Mark Fannin, MD
Title
President
Phone
(850) 932-5767

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X ME96388 FL Primary

Addresses

Primary practice location

3575 Gulf Breeze Pkwy
Gulf Breeze, FL 32563-3407

Mailing address

3575 Gulf Breeze Pkwy
Gulf Breeze, FL 32563-3407
Phone (850) 932-5767

National Provider Directory

National Provider Directory

Locations

3575 Gulf Breeze Pkwy
Gulf Breeze, FL 32563
Phone (850) 332-6339

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1323216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323388800000",
    "number": "1396013272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3575 GULF BREEZE PKWY",
            "city": "GULF BREEZE",
            "state": "FL",
            "postal_code": "325633407",
            "telephone_number": "850-932-5767",
            "fax_number": "850-932-5774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3575 GULF BREEZE PKWY",
            "city": "GULF BREEZE",
            "state": "FL",
            "postal_code": "325633407",
            "telephone_number": "850-932-5767",
            "fax_number": "850-932-5774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL WELLNESS INSTITUTE OF AMERICA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-07",
        "last_updated": "2011-12-09",
        "status": "A",
        "authorized_official_last_name": "FANNIN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "850-932-5767",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": "FL",
            "license": "ME96388",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gulf Breeze, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.