Provider Demographics
NPI:1962464222
Name:MELDRUM, DAVID GARTH (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GARTH
Last Name:MELDRUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4780 VILLAGE PLAZA LOOP STE 110
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6624
Mailing Address - Country:US
Mailing Address - Phone:541-762-1500
Mailing Address - Fax:541-393-8035
Practice Address - Street 1:4780 VILLAGE PLAZA LOOP STE 110
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6624
Practice Address - Country:US
Practice Address - Phone:541-762-1500
Practice Address - Fax:541-393-8035
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD257112082S0099X, 2082S0105X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR269810Medicaid
ORR14220Medicare PIN