Provider Demographics
NPI:1003073362
Name:MELTON, TOBI G
Entity Type:Individual
Prefix:
First Name:TOBI
Middle Name:G
Last Name:MELTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14334 S CAMINO RIO ABAJO
Mailing Address - Street 2:
Mailing Address - City:SAHUARITA
Mailing Address - State:AZ
Mailing Address - Zip Code:85629-8504
Mailing Address - Country:US
Mailing Address - Phone:520-549-8756
Mailing Address - Fax:
Practice Address - Street 1:14334 S CAMINO RIO ABAJO
Practice Address - Street 2:
Practice Address - City:SAHUARITA
Practice Address - State:AZ
Practice Address - Zip Code:85629-8504
Practice Address - Country:US
Practice Address - Phone:520-549-8756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ550969171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ550969OtherSTATE OF ARIZONA