Healthcare Provider Details

I. General information

NPI: 1164741864
Provider Name (Legal Business Name): DOUGLAS CARL MELZER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2010
Last Update Date: 04/06/2020
Certification Date: 04/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W BROADWAY ST
MISSOULA MT
59802-4008
US

IV. Provider business mailing address

500 W BROADWAY ST
MISSOULA MT
59802-4008
US

V. Phone/Fax

Practice location:
  • Phone: 303-720-9622
  • Fax:
Mailing address:
  • Phone: 303-720-9622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number52846
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: