Healthcare Provider Details

I. General information

NPI: 1679919724
Provider Name (Legal Business Name): RYAN DARYL MELVIN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2013
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 W BALDWIN RD STE C
PANAMA CITY FL
32405-3359
US

IV. Provider business mailing address

625 W BALDWIN RD STE C
PANAMA CITY FL
32405-3359
US

V. Phone/Fax

Practice location:
  • Phone: 850-769-0329
  • Fax: 844-563-8135
Mailing address:
  • Phone: 850-769-0329
  • Fax: 844-563-8135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberOS17630
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: