Provider Demographics
NPI:1306847892
Name:ST. JOHN, MELODY D (MD)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:D
Last Name:ST. JOHN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21850
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71903-1850
Mailing Address - Country:US
Mailing Address - Phone:501-627-1800
Mailing Address - Fax:501-627-1899
Practice Address - Street 1:1662 HIGDON FERRY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6999
Practice Address - Country:US
Practice Address - Phone:501-520-5476
Practice Address - Fax:501-627-1843
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC7981207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR121122001Medicaid
AR55225Medicare ID - Type Unspecified
F18624Medicare UPIN