Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | MD0000012172 | TN |
NPI | 1003815572 |
---|---|
Provider Name | Danny L Melson |
First Address | Shelbyville, TN 37160-2303 |
Second Address | Shelbyville, TN 37160-2303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2005 |
Last Update Date | 01/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B04095 | (02) |