Healthcare Provider Details

I. General information

NPI: 1265425482
Provider Name (Legal Business Name): MELANIE C FIRMIN M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 05/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 PECAN PARK AVE SUITE C
ALEXANDRIA LA
71303-3363
US

IV. Provider business mailing address

PO BOX 911
ALEXANDRIA LA
71309-0911
US

V. Phone/Fax

Practice location:
  • Phone: 318-473-9267
  • Fax: 318-445-0771
Mailing address:
  • Phone: 318-473-9267
  • Fax: 318-445-0771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number12659
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: