Provider Demographics
NPI:1760587653
Name:MIDGLEY, MELINDA M (MD)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:M
Last Name:MIDGLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3605 S WEST TEMPLE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-4409
Mailing Address - Country:US
Mailing Address - Phone:801-506-0000
Mailing Address - Fax:801-506-0010
Practice Address - Street 1:3605 S WEST TEMPLE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-4409
Practice Address - Country:US
Practice Address - Phone:801-506-0000
Practice Address - Fax:801-506-0010
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4792541-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT670074OtherDESERET MUTUAL BENEFIT AS
UT870293873MIDOtherEMIA
UT107008945101OtherSELECT HEALTH
UT63122OtherPEHP
UT47925411200001OtherBLUE CROSS/BLUE SHIELD
UTD3560Medicaid
UT87029387384062B002OtherTRICARE
UTQM0000046556OtherALTIUS
UT870293873MIDOtherEMIA
UTQM0000046556OtherALTIUS
UT47925411200001OtherBLUE CROSS/BLUE SHIELD