Provider Demographics
NPI:1104870088
Name:AMANN, JOHN C (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:AMANN
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 1:50 2ND ST SE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-6300
Mailing Address - Country:US
Mailing Address - Phone:863-293-2107
Mailing Address - Fax:863-298-8487
Practice Address - Street 1:50 2ND ST SE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-6300
Practice Address - Country:US
Practice Address - Phone:863-293-2107
Practice Address - Fax:863-298-8487
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43577174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL035922000Medicaid
FLE23011Medicare UPIN
FL035922000Medicaid