Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD2007-0654 | NM |
N | 207ND0101X | MOHS-Micrographic Surgeon | MD2007-0654 | NM |
N | 207NS0135X | Procedural Dermatology | MD2007-0654 | NM |
NPI | 1154652295 |
---|---|
Provider Name | Dr. David Michael Melamed |
First Address | Albuquerque, NM 87110-6457 |
Second Address | Albuquerque, NM 87110-6457 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 03/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E75223 | (02) | IL |