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General NPI Number Information
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NPI Number | 1457576910
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Entity Type | Organization
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Legal Business Name | BAY OAKS ORTHOPAEDICS & SPORTS MEDICINE, P.A.
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 09/16/2010
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Provider Practice Location Address
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Address Line | 1051 PINELOCH DR SUITE 100
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City | HOUSTON
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State | TX
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Zip | 77062-2742
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Country | US
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Telephone | 281-286-3500
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Fax | 281-286-3553
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Provider Business Mailing Address
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Address Line | 1051 PINELOCH DR SUITE 100
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City | HOUSTON
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State | TX
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Zip | 77062-2742
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Country | US
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Telephone | 281-286-3500
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Fax | 281-286-3553
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Authorized Official
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Title or Position | ORTHOPAEDIC SURGEON
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Name | DR. ANTHONY STEPHEN MELILLO
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Credential | M.D.
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Telephone | 281-286-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | J8057
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License Number State | TX
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