Provider Demographics
NPI:1457327025
Name:DEVALON, MELISSA (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:DEVALON
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 1:2 SOUTH CASCADE AVENUE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1604
Mailing Address - Country:US
Mailing Address - Phone:719-538-2900
Mailing Address - Fax:719-538-2961
Practice Address - Street 1:15909 JACKSON CREEK PARKWAY
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132
Practice Address - Country:US
Practice Address - Phone:719-522-1133
Practice Address - Fax:719-481-1620
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31126207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01311265Medicaid
CO01311265Medicaid
COX7148Medicare PIN