Provider Demographics
NPI:1770509549
Name:ROOF, MELVIN C (DO)
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:C
Last Name:ROOF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 702
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-0702
Mailing Address - Country:US
Mailing Address - Phone:660-785-1000
Mailing Address - Fax:660-785-1237
Practice Address - Street 1:800 W JEFFERSON ST
Practice Address - Street 2:NORTHEAST REGIONAL MEDICAL CENTER
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-1443
Practice Address - Country:US
Practice Address - Phone:660-785-1000
Practice Address - Fax:660-785-1237
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO36957207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0976845Medicaid
IA2970012Medicaid
MO8298OtherHEALTHCARE USA (GROUP)
MO242695948Medicaid
050072810OtherRAILROAD MEDICARE
CG4336OtherRAILROAD MEDICARE
MO80173OtherHEALTHCARE USA
IA0976845Medicaid
MO242695948Medicaid