Provider Demographics
NPI:1235206723
Name:MELTON, JOHN W (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:MELTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:134 TRAVOIS RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-1673
Mailing Address - Country:US
Mailing Address - Phone:502-899-1193
Mailing Address - Fax:502-897-7233
Practice Address - Street 1:1850 STATE ST
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4990
Practice Address - Country:US
Practice Address - Phone:502-899-1193
Practice Address - Fax:502-897-7233
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY265022084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000187099OtherANTHEM
KY1138468OtherPASSPORT
KY64265028Medicaid
KY0664701Medicare PIN
KY000000187099OtherANTHEM
KYF07392Medicare UPIN