Provider Demographics
NPI:1376657932
Name:BEAGLE, MELISSA DIANE (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:DIANE
Last Name:BEAGLE
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 1:4545 NAVAJO ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-2440
Mailing Address - Country:US
Mailing Address - Phone:303-602-6700
Mailing Address - Fax:303-602-6700
Practice Address - Street 1:4545 NAVAJO ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-2440
Practice Address - Country:US
Practice Address - Phone:303-602-6700
Practice Address - Fax:303-602-6700
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO46998207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine