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1881687465

NPI Code Detail

MEDICARE: REED GRANT MELLOR MD

MEDICARE: REED GRANT MELLOR 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
1	2080A0000X	Pediatric Adolescent Medicine Physician	A97111	CA
2	208000000X	Pediatrics Physician	34996	IA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	420681060B8	OTHER	IA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	G021	OTHER	IA	TRIWEST
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	34171	OTHER	IA	WELLMARK BCBS OF IOWA
5	220789	OTHER	IA	IOWA HEALTH SOLUTIONS

General Provider Information

NPI Number	:	1881687465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REED GRANT MELLOR MD

Provider Business Mailing Address
First Line	:	7373 WEST LN
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95210-3377
Country	:	US
Telephone Number	:	209-476-3094
Fax Number	:

Provider Business Practice Location Address
First Line	:	7373 WEST LN
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95210-3377
Country	:	US
Telephone Number	:	209-476-3094
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2005
Last Update Date	:	01/10/2022

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Directions to “ REED GRANT MELLOR MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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