Provider Demographics
NPI:1740432863
Name:AMBROSE, MELTON CROSBY SR (MD)
Entity Type:Individual
Prefix:DR
First Name:MELTON
Middle Name:CROSBY
Last Name:AMBROSE
Suffix:SR
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 1:329 BEECH HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:KILLEN
Mailing Address - State:AL
Mailing Address - Zip Code:35645-8403
Mailing Address - Country:US
Mailing Address - Phone:256-757-1446
Mailing Address - Fax:
Practice Address - Street 1:329 BEECH HOLLOW RD
Practice Address - Street 2:
Practice Address - City:KILLEN
Practice Address - State:AL
Practice Address - Zip Code:35645-8403
Practice Address - Country:US
Practice Address - Phone:256-757-1446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3998207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology