Healthcare Provider Details

I. General information

NPI: 1619219557
Provider Name (Legal Business Name): MELVYN ROY FLETCHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2013
Last Update Date: 03/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 W WOOD DR
KEY BISCAYNE FL
33149-2425
US

IV. Provider business mailing address

204 W WOOD DR
KEY BISCAYNE FL
33149-2425
US

V. Phone/Fax

Practice location:
  • Phone: 305-298-6057
  • Fax:
Mailing address:
  • Phone: 305-298-6057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME57123
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: