Provider Demographics
NPI:1114304730
Name:MELSON, MATTHEW TYLER (DO)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:TYLER
Last Name:MELSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:117 RENAISSANCE ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-1207
Mailing Address - Country:US
Mailing Address - Phone:256-765-0002
Mailing Address - Fax:256-765-0022
Practice Address - Street 1:117 RENAISSANCE ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1207
Practice Address - Country:US
Practice Address - Phone:256-765-0002
Practice Address - Fax:256-765-0022
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-04
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO.1769207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine