Provider Demographics
NPI:1962532655
Name:MARIANNA OB GYN ASSOCIATES P A
Entity type:Organization
Organization Name:MARIANNA OB GYN ASSOCIATES P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ORLANDO
Authorized Official - Middle Name:S
Authorized Official - Last Name:MUNIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-482-6484
Mailing Address - Street 1:4230 HOSPITAL DRIVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-1955
Mailing Address - Country:US
Mailing Address - Phone:850-482-6484
Mailing Address - Fax:850-482-5713
Practice Address - Street 1:4230 HOSPITAL DR
Practice Address - Street 2:SUITE 209
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-1955
Practice Address - Country:US
Practice Address - Phone:850-482-6484
Practice Address - Fax:850-482-5713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0068116174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21956OtherBCBS GROUP
FL254870400Medicaid
FL254870400Medicaid