Provider Demographics
NPI:1679919724
Name:MELVIN, RYAN DARYL (DO)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:DARYL
Last Name:MELVIN
Suffix:
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 1:625 W BALDWIN RD STE C
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-3359
Mailing Address - Country:US
Mailing Address - Phone:850-769-0329
Mailing Address - Fax:844-563-8135
Practice Address - Street 1:625 W BALDWIN RD STE C
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-3359
Practice Address - Country:US
Practice Address - Phone:850-769-0329
Practice Address - Fax:844-563-8135
Is Sole Proprietor?:No
Enumeration Date:2013-05-16
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS17630207RC0000X
MI5101020251207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111497100Medicaid