Healthcare Provider Details

I. General information

NPI: 1235246471
Provider Name (Legal Business Name): ROBERT L MELLON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 RALEY BLVD
CHICO CA
95928-8347
US

IV. Provider business mailing address

537 MADRONE AVE
CHICO CA
95926-1720
US

V. Phone/Fax

Practice location:
  • Phone: 530-898-1201
  • Fax:
Mailing address:
  • Phone: 301-466-8428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101240393
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA124377
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: