Healthcare Provider Details

I. General information

NPI: 1316050081
Provider Name (Legal Business Name): TERRY D MELENDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N 1220 E STE 7
AMERICAN FORK UT
84003-2089
US

IV. Provider business mailing address

1248 E 90 N # 300
AMERICAN FORK UT
84003-2956
US

V. Phone/Fax

Practice location:
  • Phone: 801-756-9635
  • Fax: 801-756-8020
Mailing address:
  • Phone: 801-756-9635
  • Fax: 801-216-8357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number3205681205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: