Provider Demographics
NPI:1316944788
Name:PACKEY, DAVID J (MD PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:PACKEY
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 PINE ST
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3116
Mailing Address - Country:US
Mailing Address - Phone:321-984-9400
Mailing Address - Fax:321-984-0150
Practice Address - Street 1:1333 PINE ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3116
Practice Address - Country:US
Practice Address - Phone:321-984-9400
Practice Address - Fax:321-984-0150
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME664962084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF86461Medicare UPIN
FL25513YMedicare ID - Type Unspecified