Provider Demographics
NPI:1497388656
Name:MELTON, RICHARD ALAN III
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALAN
Last Name:MELTON
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 KILKENNY WAY
Mailing Address - Street 2:
Mailing Address - City:CANTONMENT
Mailing Address - State:FL
Mailing Address - Zip Code:32533-6885
Mailing Address - Country:US
Mailing Address - Phone:850-516-9323
Mailing Address - Fax:
Practice Address - Street 1:401 KILKENNY WAY
Practice Address - Street 2:
Practice Address - City:CANTONMENT
Practice Address - State:FL
Practice Address - Zip Code:32533-6885
Practice Address - Country:US
Practice Address - Phone:850-516-9323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer