Provider Demographics
NPI:1114001559
Name:ANAYAS, MARCELO RAMOS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCELO
Middle Name:RAMOS
Last Name:ANAYAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 N STONE ST
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-2511
Mailing Address - Country:US
Mailing Address - Phone:386-738-1792
Mailing Address - Fax:
Practice Address - Street 1:810 COMMED BLVD
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8322
Practice Address - Country:US
Practice Address - Phone:386-774-1155
Practice Address - Fax:386-775-2692
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48720207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL043416700Medicaid
FL103869OtherMEDICARE