Healthcare Provider Details

I. General information

NPI: 1689627887
Provider Name (Legal Business Name): WADE H MELVIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 MAIN ST SUITE 4
CHIPLEY FL
32428-6952
US

IV. Provider business mailing address

403 E 11TH ST STE 4
PANAMA CITY FL
32401-3409
US

V. Phone/Fax

Practice location:
  • Phone: 850-676-4926
  • Fax: 850-676-4929
Mailing address:
  • Phone: 850-767-3350
  • Fax: 850-767-3353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME 42465
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: