Provider Demographics
NPI:1689627887
Name:MELVIN, WADE H (MD)
Entity Type:Individual
Prefix:
First Name:WADE
Middle Name:H
Last Name:MELVIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 E 11TH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-3409
Mailing Address - Country:US
Mailing Address - Phone:850-767-3350
Mailing Address - Fax:850-767-3353
Practice Address - Street 1:1414 MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:CHIPLEY
Practice Address - State:FL
Practice Address - Zip Code:32428-6952
Practice Address - Country:US
Practice Address - Phone:850-676-4926
Practice Address - Fax:850-676-4929
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 42465207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
32072OtherBLUE CROSS
FL067715900Medicaid
D54276Medicare UPIN
FL080104807Medicare PIN
32072OtherBLUE CROSS