Basic Information
Provider Information
NPI: 1881723757
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MAYER
FirstName: MELVIN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2600 LAKE LUCIEN DR STE 180
Address2:  
City: MAITLAND
State: FL
PostalCode: 327517235
CountryCode: US
TelephoneNumber: 4078752080
FaxNumber: 4078750518
Practice Location
Address1: 2610 W HORIZON RIDGE PKWY STE 203
Address2:  
City: HENDERSON
State: NV
PostalCode: 890522870
CountryCode: US
TelephoneNumber: 7024078412
FaxNumber: 7024078416
Other Information
ProviderEnumerationDate: 03/05/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000X6625NVY Allopathic & Osteopathic PhysiciansSurgery 

No ID Information.


Home