Provider Demographics
NPI:1922654367
Name:JOSEPH C MELVIN MD PC
Entity Type:Organization
Organization Name:JOSEPH C MELVIN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:C
Authorized Official - Last Name:MELVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-263-1621
Mailing Address - Street 1:PO BOX 150610
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84415
Mailing Address - Country:US
Mailing Address - Phone:801-476-9200
Mailing Address - Fax:801-476-9208
Practice Address - Street 1:1250 EAST 3900 SOUTH STE 320
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124
Practice Address - Country:US
Practice Address - Phone:801-263-1621
Practice Address - Fax:801-263-1647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty