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NPI Code Detail

MEDICARE: MELBOURNE MEDICINE & SURGERY ASSOC

MEDICARE: MELBOURNE MEDICINE & SURGERY ASSOC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistME46431FL

General Provider Information

NPI Number : 1396889150
Entity Type Code : Organization
Provider Name (Legal Business Name) : MELBOURNE MEDICINE & SURGERY ASSOC
Provider Business Mailing Address
First Line : 1251 HICKORY ST STE A
Second Line :
City : MELBOURNE
State : FL
Zip : 32901-3221
Country : US
Telephone Number : 321-723-3113
Fax Number : 321-768-0491
Provider Business Practice Location Address
First Line : 1251 HICKORY ST STE A
Second Line :
City : MELBOURNE
State : FL
Zip : 32901-3221
Country : US
Telephone Number : 321-723-3113
Fax Number : 321-768-0491
Authorized Official
Title or Position : PRESIDENT
Name : DR. JOHN M GAYDEN JR.
Credential : MD
Telephone Number : 321-723-3113
Provider Enumeration Date : 02/16/2007
Last Update Date : 07/16/2007

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Directions to “MELBOURNE MEDICINE & SURGERY ASSOC ” Practice Location

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