Provider Demographics
NPI:1417182932
Name:MELE, PHILLIP MICHAEL JR (DO)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:MICHAEL
Last Name:MELE
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 WILLIAMS AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32118-3339
Mailing Address - Country:US
Mailing Address - Phone:386-898-4359
Mailing Address - Fax:
Practice Address - Street 1:331 WILLIAMS AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32118-3339
Practice Address - Country:US
Practice Address - Phone:386-898-4359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10602207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine