Healthcare Provider Details

I. General information

NPI: 1053429019
Provider Name (Legal Business Name): EUGENE AVERY MELVIN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 02/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3861 OAKWATER CIR STE 2
ORLANDO FL
32806-6258
US

IV. Provider business mailing address

3861 OAKWATER CIR STE 2
ORLANDO FL
32806-6258
US

V. Phone/Fax

Practice location:
  • Phone: 407-649-7800
  • Fax: 407-649-9881
Mailing address:
  • Phone: 407-649-7800
  • Fax: 407-649-9881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME0055539
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: