Provider Demographics
NPI:1598751786
Name:MELLUM, SCOTT DUANE (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:DUANE
Last Name:MELLUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3810
Mailing Address - Country:US
Mailing Address - Phone:530-894-8944
Mailing Address - Fax:530-894-8905
Practice Address - Street 1:101 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3810
Practice Address - Country:US
Practice Address - Phone:530-894-8944
Practice Address - Fax:530-894-8905
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81272207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG05288Medicare UPIN