Healthcare Provider Details

I. General information

NPI: 1922654367
Provider Name (Legal Business Name): JOSEPH C MELVIN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 EAST 3900 SOUTH STE 320
SALT LAKE CITY UT
84124
US

IV. Provider business mailing address

PO BOX 150610
OGDEN UT
84415
US

V. Phone/Fax

Practice location:
  • Phone: 801-263-1621
  • Fax: 801-263-1647
Mailing address:
  • Phone: 801-476-9200
  • Fax: 801-476-9208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH C MELVIN
Title or Position: PRESIDENT
Credential: MD
Phone: 801-263-1621