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General NPI Number Information
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NPI Number | 1013025162
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Entity Type | Organization
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Legal Business Name | PAIN CENTER OF CENTRAL FL PA
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Dates
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Enumeration Date | 08/28/2006
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Last Update Date | 07/14/2010
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Provider Practice Location Address
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Address Line | 3861 OAKWATER CIR STE 2
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City | ORLANDO
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State | FL
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Zip | 32806-6258
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Country | US
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Telephone | 407-649-7800
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Fax | 407-649-9881
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Provider Business Mailing Address
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Address Line | 3861 OAKWATER CIR STE 2
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City | ORLANDO
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State | FL
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Zip | 32806-6258
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Country | US
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Telephone | 407-649-7800
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Fax | 407-649-9881
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EUGENE AVERY MELVIN JR.
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Credential | MD
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Telephone | 407-649-7800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | ME0055539
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License Number State | FL
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