Provider Demographics
NPI:1922314830
Name:MELISA A. MONSON DPM PC
Entity Type:Organization
Organization Name:MELISA A. MONSON DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MONSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:541-689-3332
Mailing Address - Street 1:45 DIVISION AVE STE B
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-2483
Mailing Address - Country:US
Mailing Address - Phone:541-689-3332
Mailing Address - Fax:541-284-2955
Practice Address - Street 1:45 DIVISION AVE STE B
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-2483
Practice Address - Country:US
Practice Address - Phone:541-689-3332
Practice Address - Fax:541-284-2955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-30
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00261213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU53062Medicare UPIN