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General NPI Number Information
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NPI Number | 1275575664
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Entity Type | Individual
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Provider Name | DAVID MYATT MELNICZEK MD
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Gender | Male
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 01/28/2020
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Provider Practice Location Address
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Address Line | 777 S STATE HIGHWAY 49 STE 1&2
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City | JACKSON
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State | CA
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Zip | 95642-2685
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Country | US
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Telephone | 209-256-8200
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Fax | 209-256-8204
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Provider Business Mailing Address
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Address Line | 777 S STATE HIGHWAY 49 STE 1&2
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City | JACKSON
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State | CA
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Zip | 95642-2685
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Country | US
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Telephone | 209-256-8200
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Fax | 209-256-8204
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A92447
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License Number State | CA
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