Healthcare Provider Details

I. General information

NPI: 1508862814
Provider Name (Legal Business Name): RICHARD M MELTZER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15100 LOS GATOS BLVD STE 4
LOS GATOS CA
95032-2028
US

IV. Provider business mailing address

15100 LOS GATOS BLVD STE 4
LOS GATOS CA
95032-2028
US

V. Phone/Fax

Practice location:
  • Phone: 408-358-6234
  • Fax: 408-358-3389
Mailing address:
  • Phone: 408-358-6234
  • Fax: 408-358-3389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE2929
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: