Healthcare Provider Details

I. General information

NPI: 1598762841
Provider Name (Legal Business Name): NATHAN C MELOY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 05/21/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 MAPLECREST RD STE 12
BETTENDORF IA
52722-2799
US

IV. Provider business mailing address

2535 MAPLECREST RD STE 12
BETTENDORF IA
52722-2799
US

V. Phone/Fax

Practice location:
  • Phone: 563-421-3555
  • Fax:
Mailing address:
  • Phone: 563-421-3555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number036112357
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number5101017187
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number51723-21
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: