Provider Demographics
NPI:1083707079
Name:ANO & ANO MD PA
Entity Type:Organization
Organization Name:ANO & ANO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FERMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-761-5682
Mailing Address - Street 1:2089 S RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-2240
Mailing Address - Country:US
Mailing Address - Phone:386-761-5682
Mailing Address - Fax:386-760-4142
Practice Address - Street 1:2089 S RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-2240
Practice Address - Country:US
Practice Address - Phone:386-761-5682
Practice Address - Fax:386-760-4142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0020477207Q00000X
FLME00298942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34720Medicare PIN