Provider Demographics
NPI:1407842313
Name:MONSON, MELISA A (DPM PC)
Entity Type:Individual
Prefix:DR
First Name:MELISA
Middle Name:A
Last Name:MONSON
Suffix:
Gender:F
Credentials:DPM PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 DIVISION AVE STE B
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-2483
Mailing Address - Country:US
Mailing Address - Phone:541-689-3332
Mailing Address - Fax:541-284-2955
Practice Address - Street 1:45 DIVISION AVE STE B
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-2483
Practice Address - Country:US
Practice Address - Phone:541-689-3332
Practice Address - Fax:541-284-2955
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00261213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU53062Medicare UPIN
ORR107355Medicare PIN
OR4736970001Medicare NSC