Healthcare Provider Details

I. General information

NPI: 1922314830
Provider Name (Legal Business Name): MELISA A. MONSON DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2010
Last Update Date: 11/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 DIVISION AVE STE B
EUGENE OR
97404-2483
US

IV. Provider business mailing address

45 DIVISION AVE STE B
EUGENE OR
97404-2483
US

V. Phone/Fax

Practice location:
  • Phone: 541-689-3332
  • Fax: 541-284-2955
Mailing address:
  • Phone: 541-689-3332
  • Fax: 541-284-2955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberDP00261
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. MELISA A MONSON
Title or Position: PRESIDENT
Credential: DPM
Phone: 541-689-3332