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NPI Code Detail

MEDICARE: DIANE MARIE MELANCON MD

MEDICARE: DIANE MARIE MELANCON MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianDR.0043829CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205836426
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANE MARIE MELANCON MD
Provider Business Mailing Address
First Line : PO BOX 1687
Second Line :
City : GRAND JUNCTION
State : CO
Zip : 81502-1687
Country : US
Telephone Number : 970-256-6322
Fax Number : 970-263-2691
Provider Business Practice Location Address
First Line : 2596 F RD
Second Line :
City : GRAND JUNCTION
State : CO
Zip : 81505-1443
Country : US
Telephone Number : 970-254-3180
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2005
Last Update Date : 11/24/2015

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