Organization
LOGGERHEAD MEDICAL LLC
Active
Other names
Advanced Pain and Neuromuscular Consultants of Brevard
Organization subpart
No
Provider details
NPI number
Authorized official
NANCY L LAYTON M.D. (OWNER)
(321) 729-8223
Entity
Organization
Contact information
Practice address
307 E NEW HAVEN AVE, MELBOURNE, FL 32901-4576
(321) 729-8223
(321) 729-6252
Mailing address
PO BOX 3123, ST AUGUSTINE, FL 32085-3123
(904) 824-4990
(904) 824-2226
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
ME51048
FL
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
ME105112
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
275274301
—
FL
05
—
275274302
—
FL
01
—
39339
BCBS
FL
01
—
DC0738
MEDICARE RAILROAD
FL
Enumeration date
07/10/2006
Last updated
09/15/2011
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