MEDICARE: DR. JORGE A MELENDEZ MD

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
1	208600000X	Surgery Physician	ME 24870	FL

General Provider Information

NPI Number	:	1861578627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORGE A MELENDEZ MD

Provider Business Mailing Address
First Line	:	4510 OLD ORCHARD DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-8654
Country	:	US
Telephone Number	:	813-963-2006
Fax Number	:	813-963-2006

Provider Business Practice Location Address
First Line	:	4510 OLD ORCHARD DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-8654
Country	:	US
Telephone Number	:	813-963-2006
Fax Number	:	813-963-2006

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	07/08/2007

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