Provider Demographics
NPI:1396889150
Name:MELBOURNE MEDICINE & SURGERY ASSOC
Entity type:Organization
Organization Name:MELBOURNE MEDICINE & SURGERY ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GAYDEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:321-723-3113
Mailing Address - Street 1:1251 HICKORY ST STE A
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3221
Mailing Address - Country:US
Mailing Address - Phone:321-723-3113
Mailing Address - Fax:321-768-0491
Practice Address - Street 1:1251 HICKORY ST STE A
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3221
Practice Address - Country:US
Practice Address - Phone:321-723-3113
Practice Address - Fax:321-768-0491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46431174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty