Provider Demographics
NPI:1508861402
Name:BEHRINGER, MELISSA BLAIR (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:BLAIR
Last Name:BEHRINGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1023 MEDICAL CENTER PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36701-6780
Mailing Address - Country:US
Mailing Address - Phone:334-875-4184
Mailing Address - Fax:334-874-3511
Practice Address - Street 1:1023 MEDICAL CENTER PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-6780
Practice Address - Country:US
Practice Address - Phone:334-875-4184
Practice Address - Fax:334-874-3511
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL16514207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000060982Medicaid
AL511-57158OtherBLUE CROSS
AL000060982Medicaid