Healthcare Provider Details

I. General information

NPI: 1306847892
Provider Name (Legal Business Name): MELODY D ST. JOHN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1662 HIGDON FERRY RD SUITE 100
HOT SPRINGS AR
71913-6999
US

IV. Provider business mailing address

PO BOX 21850
HOT SPRINGS AR
71903-1850
US

V. Phone/Fax

Practice location:
  • Phone: 501-520-5476
  • Fax: 501-627-1843
Mailing address:
  • Phone: 501-627-1800
  • Fax: 501-627-1899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberC7981
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: