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General NPI Number Information
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NPI Number | 1639379910
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Entity Type | Organization
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Legal Business Name | W ROBERT ADDINGTON II DO LLC
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Dates
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Enumeration Date | 07/24/2007
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Last Update Date | 04/11/2019
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Provider Practice Location Address
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Address Line | 301 SHERIDAN RD
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City | MELBOURNE
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State | FL
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Zip | 32901-3160
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Country | US
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Telephone | 321-951-8137
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Fax | 321-951-8138
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Provider Business Mailing Address
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Address Line | 301 SHERIDAN RD
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City | MELBOURNE
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State | FL
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Zip | 32901-3160
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Country | US
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Telephone | 321-951-8137
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Fax | 321-951-8138
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. ANN M MILLER
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Credential |
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Telephone | 321-951-8137
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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 | OS0006793
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License Number State | FL
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