Healthcare Provider Details

I. General information

NPI: 1730108358
Provider Name (Legal Business Name): PHILIP BATSON MELLEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 BEACH DR
GULFPORT MS
39507-1553
US

IV. Provider business mailing address

1800 BEACH DR
GULFPORT MS
39507-1553
US

V. Phone/Fax

Practice location:
  • Phone: 228-897-4514
  • Fax: 228-897-4481
Mailing address:
  • Phone: 228-897-4514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0005X
TaxonomyHypertension Specialist Physician
License Number19823
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: