Healthcare Provider Details

I. General information

NPI: 1477574028
Provider Name (Legal Business Name): MELODY PALMER LAND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE JACKSON MEMORIAL HOSPITAL ER DEPT, EAST TOWER FIRST FL
MIAMI FL
33136-1005
US

IV. Provider business mailing address

1611 NW 12TH AVE JACKSON MEMORIAL HOSPITAL ER DEPT, EAST TOWER FIRST FL
MIAMI FL
33136-1005
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-6913
  • Fax: 305-585-0000
Mailing address:
  • Phone: 305-585-6913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME71681
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME71681
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberME71681
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME71681
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: