Provider Demographics
NPI:1609919471
Name:MELLEN, JONATHAN SPENCER (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:SPENCER
Last Name:MELLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9305 W THOMAS RD
Mailing Address - Street 2:STE 478
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-3375
Mailing Address - Country:US
Mailing Address - Phone:623-236-8507
Mailing Address - Fax:623-236-8508
Practice Address - Street 1:9305 W THOMAS RD
Practice Address - Street 2:STE 478
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3375
Practice Address - Country:US
Practice Address - Phone:623-236-8507
Practice Address - Fax:623-236-8508
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK210986207RG0100X
AZ44619207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology