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General NPI Number Information
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NPI Number | 1134461254
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Entity Type | Organization
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Legal Business Name | PROVECTUS MEDICAL INC
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Dates
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Enumeration Date | 03/27/2013
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Last Update Date | 03/27/2013
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Provider Practice Location Address
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Address Line | 6232 N HIGHWAY 146
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City | BAYTOWN
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State | TX
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Zip | 77523-1000
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Country | US
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Telephone | 409-832-4413
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Fax | 409-212-1579
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Provider Business Mailing Address
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Address Line | 6232 N HIGHWAY 146
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City | BAYTOWN
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State | TX
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Zip | 77523-1000
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Country | US
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Telephone | 409-832-4413
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Fax | 409-212-1579
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT ALAN O'NEAL
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Credential | D.C.
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Telephone | 409-839-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State | TX
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