Provider Demographics
NPI:1225467541
Name:MELGAARD, ERICK IV
Entity Type:Individual
Prefix:MR
First Name:ERICK
Middle Name:
Last Name:MELGAARD
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 E CEDAR CT APT D
Mailing Address - Street 2:
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-3115
Mailing Address - Country:US
Mailing Address - Phone:970-424-2492
Mailing Address - Fax:
Practice Address - Street 1:805 E CEDAR CT APT D
Practice Address - Street 2:
Practice Address - City:FRUITA
Practice Address - State:CO
Practice Address - Zip Code:81521-3115
Practice Address - Country:US
Practice Address - Phone:970-424-2492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory