Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | ME144060 | FL |
NPI | 1003347337 |
---|---|
Provider Name | Mary Elizabeth Melvin |
First Address | Marianna, FL 32446-2127 |
Second Address | Marianna, FL 32446-2127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2017 |
Last Update Date | 26/05/2020 |