Provider Demographics
NPI:1487749487
Name:NANFRO, JOHN JOSEPH (MD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JOSEPH
Last Name:NANFRO
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 1:4230 HOSPITAL DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-1917
Mailing Address - Country:US
Mailing Address - Phone:850-526-6707
Mailing Address - Fax:850-526-5021
Practice Address - Street 1:4230 HOSPITAL DR
Practice Address - Street 2:STE 101
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-1927
Practice Address - Country:US
Practice Address - Phone:850-526-7607
Practice Address - Fax:850-526-5021
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86297207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE8805YMedicare ID - Type Unspecified
FLD30513Medicare UPIN