BRIAN J MALLETTE DPM LLC
Medical Practice at Harbor City Blvd, Melbourne, FL

License number
Florida PO2692
Category
Medical Practice
Type
Foot & Ankle Surgery
Owner
Name: DR. BRIAN J. MALLETTE D.P.M.
Title: PRESIDENT
Phone: (321) 728-0117
Address
Address
200 S Harbor City Blvd, Melbourne, FL 32901
National Provider ID: 1073755963
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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BRIAN J. MALLETTE, D.P.M., LLC

Melbourne, FL

Status:
Inactive
Industry:
Podiatrist's Office
Inactive reason:
REINSTATEMENT
Registration:
Mar 5, 2009
Inactive since:
Apr 14, 2011
Addresses:
200 S Hbr City Blvd SUITE #102, Melbourne, FL 32901 (Physical)
309 Carmel Dr, Melbourne, FL 32940 (Mailing)
State ID:
L09000021805
Business type:
Florida Limited Liability Company
Managers:
Brian Jd.p.m. Mallette (Manager), 309 Carmel Dr, Melbourne, FL 32940 (Physical),Claudia Rd.p.m. Mallette (Manager), 309 Carmel Dr, Melbourne, FL 32940 (Physical)
Agent:
Brian Mallette,309 Carmel Dr, Melbourne, FL 32940 (Physical)
EIN:
264387822

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