Provider Demographics
NPI:1790195964
Name:RIES, MELISSA JO (DPM)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JO
Last Name:RIES
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6677 W THUNDERBIRD RD STE E
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-3722
Mailing Address - Country:US
Mailing Address - Phone:623-815-7800
Mailing Address - Fax:623-815-7900
Practice Address - Street 1:6677 W THUNDERBIRD RD STE E
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-3722
Practice Address - Country:US
Practice Address - Phone:623-815-7800
Practice Address - Fax:623-815-7900
Is Sole Proprietor?:No
Enumeration Date:2014-04-28
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ0840213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ298498Medicaid