Provider Demographics
NPI:1457381907
Name:MELLMAN, ROBERT LEON (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEON
Last Name:MELLMAN
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 1:1000 NW 9TH COURT
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2268
Mailing Address - Country:US
Mailing Address - Phone:561-395-5204
Mailing Address - Fax:561-395-6177
Practice Address - Street 1:1000 NW 9TH COURT
Practice Address - Street 2:SUITE 204
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2268
Practice Address - Country:US
Practice Address - Phone:561-395-5204
Practice Address - Fax:561-395-6177
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0056917207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E54591Medicare UPIN
FL09912Medicare ID - Type Unspecified