Healthcare Provider Details

I. General information

NPI: 1700878303
Provider Name (Legal Business Name): MELANIE G HAMPTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 02/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 OSAGE EXECUTIVE CIR
HOUSE SPRINGS MO
63051-1382
US

IV. Provider business mailing address

227 E MAIN ST
FESTUS MO
63028-1952
US

V. Phone/Fax

Practice location:
  • Phone: 636-677-9977
  • Fax: 636-677-9179
Mailing address:
  • Phone: 636-931-2700
  • Fax: 636-931-5304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR2E16
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: