Provider Demographics
NPI:1053429019
Name:MELVIN, EUGENE AVERY JR (MD)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:AVERY
Last Name:MELVIN
Suffix:JR
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 1:3861 OAKWATER CIR STE 2
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-6258
Mailing Address - Country:US
Mailing Address - Phone:407-649-7800
Mailing Address - Fax:407-649-9881
Practice Address - Street 1:3861 OAKWATER CIR STE 2
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-6258
Practice Address - Country:US
Practice Address - Phone:407-649-7800
Practice Address - Fax:407-649-9881
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0055539207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL09101OtherBCBS
FL1669423007OtherCIGNA HMO
FL1669423001OtherCIGNA PPO
FL208633OtherAVMED
FLR3492OtherTRICARE
FL208633OtherAVMED
FL09101OtherBCBS