Provider Demographics
NPI:1982085718
Name:MELVILLE, BRIAN TYLER (DO)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:TYLER
Last Name:MELVILLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4403 HARRISON BLVD STE 3875
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-3332
Mailing Address - Country:US
Mailing Address - Phone:801-387-7950
Mailing Address - Fax:
Practice Address - Street 1:3945 WASHINGTON BLVD STE A
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-1825
Practice Address - Country:US
Practice Address - Phone:801-479-4105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT76705991204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty