Individual
BRIAN JOSEPH MALLETTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
200 S HARBOR CITY BLVD, SUITE 102, MELBOURNE, FL 32901-1384
(321) 728-0117
(321) 728-0151
Mailing address
200 S HARBOR CITY BLVD, SUITE 102, MELBOURNE, FL 32901-1384
(321) 728-0117
(321) 728-0151
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
PO2692
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2605728
AETNA
FL
05
—
261086800
—
FL
01
—
480031393
RAILROAD MEDICARE
FL
01
—
5532704
AETNA
FL
01
—
65643
BLUE CROSS BLUE SHIELD
FL
01
—
9415057001
CIGNA
FL
Enumeration date
11/29/2005
Last updated
12/08/2015
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