Provider Demographics
NPI:1609850775
Name:MELTON, MICHAEL S (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:MELTON
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 1:2500 NE NEFF RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6015
Mailing Address - Country:US
Mailing Address - Phone:541-382-4321
Mailing Address - Fax:
Practice Address - Street 1:61250 SE COOMBS PL
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3704
Practice Address - Country:US
Practice Address - Phone:541-706-5930
Practice Address - Fax:541-706-5931
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90790207Q00000X
ORMD201470207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7159625OtherAETNA
FL9227094002OtherCIGNA
FL48499OtherBLUE CROSS BLUE SHIELD
FLP00185798OtherRAILROAD MEDICARE
FL244227OtherWELLCARE
FL270432300Medicaid
FL3570709OtherAETNA
FL270432300Medicaid
FL244227OtherWELLCARE