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NPI Code Detail

MEDICARE: GREGORY B MELBY MD

MEDICARE: GREGORY B MELBY MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianMD24292OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1316929920
Entity Type Code : Individual
Provider Name (Legal Business Name) : GREGORY B MELBY MD
Provider Business Mailing Address
First Line : 1620 E 12TH ST
Second Line :
City : THE DALLES
State : OR
Zip : 97058-3213
Country : US
Telephone Number : 541-296-9151
Fax Number : 541-296-9156
Provider Business Practice Location Address
First Line : 1620 E 12TH ST
Second Line :
City : THE DALLES
State : OR
Zip : 97058-3213
Country : US
Telephone Number : 541-296-9151
Fax Number : 541-296-9156
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2005
Last Update Date : 07/17/2007

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Directions to “ GREGORY B MELBY MD” Practice Location

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