Provider Demographics
NPI:1881842987
Name:VOUTSALATH, MELISSA ANN (DO)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ANN
Last Name:VOUTSALATH
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:15854 JACKSON CREEK PKWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-8662
Mailing Address - Country:US
Mailing Address - Phone:719-364-9930
Mailing Address - Fax:719-364-9939
Practice Address - Street 1:15854 JACKSON CREEK PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-8662
Practice Address - Country:US
Practice Address - Phone:719-364-9930
Practice Address - Fax:719-364-9939
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2021-05-04
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Provider Licenses
StateLicense IDTaxonomies
CODR.0054354207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO10506730Medicaid
CO10506730Medicaid