Provider Demographics
NPI:1124380506
Name:FORE, MELISSA R (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:R
Last Name:FORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:R
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:777 S NEW BALLAS RD STE 231E
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8747
Mailing Address - Country:US
Mailing Address - Phone:314-698-2500
Mailing Address - Fax:
Practice Address - Street 1:777 S NEW BALLAS RD STE 231E
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8747
Practice Address - Country:US
Practice Address - Phone:314-698-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012017898207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO152800274Medicare PIN