Provider Demographics
NPI:1134461254
Name:PROVECTUS MEDICAL INC
Entity Type:Organization
Organization Name:PROVECTUS MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:O'NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:409-839-4600
Mailing Address - Street 1:6232 N HIGHWAY 146
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77523-1000
Mailing Address - Country:US
Mailing Address - Phone:409-832-4413
Mailing Address - Fax:409-212-1579
Practice Address - Street 1:6232 N HIGHWAY 146
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77523-1000
Practice Address - Country:US
Practice Address - Phone:409-832-4413
Practice Address - Fax:409-212-1579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty